Provider Demographics
NPI:1992071112
Name:RIVERA, JEANETTE (PSYD)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. CAMINO DEL SUR CALLE FRAILE
Mailing Address - Street 2:# 436
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-225-2356
Mailing Address - Fax:
Practice Address - Street 1:BARRIO ARUZ
Practice Address - Street 2:CARR. 1 KM 18.8
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-3669
Practice Address - Country:US
Practice Address - Phone:787-225-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1072101YP2500X
PR7246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional