MEDICARE: IVISSELISE RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	5545	PR

General Provider Information

NPI Number	:	1114856267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVISSELISE RIVERA

Provider Business Mailing Address
First Line	:	URBANIZACION PROVINCIAS DEL RIO II
Second Line	:	#216
City	:	COAMO
State	:	PR
Zip	:	00769
Country	:	US
Telephone Number	:	787-201-4853
Fax Number	:

Provider Business Practice Location Address
First Line	:	URBANIZACION PROVINCIAS DEL RIO II
Second Line	:	#216
City	:	COAMO
State	:	PR
Zip	:	00769
Country	:	US
Telephone Number	:	787-201-4853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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