Healthcare Provider Details

I. General information

NPI: 1982761169
Provider Name (Legal Business Name): NILSA RIVERA PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

692 GOODLETTE RD N
NAPLES FL
34102
US

IV. Provider business mailing address

692 GOODLETTE RD N
NAPLES FL
34102
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-2425
  • Fax: 239-649-6085
Mailing address:
  • Phone: 239-434-2425
  • Fax: 239-649-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6994
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6994
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY6994
License Number StateFL

VIII. Authorized Official

Name: DR. NILSA RIVERA
Title or Position: PRESIDENT
Credential: PHD
Phone: 239-434-2425