Healthcare Provider Details

I. General information

NPI: 1043758436
Provider Name (Legal Business Name): NELYMAR RIVERA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. EL JIBARO CARR 172 KM 13.5
CIDRA PR
00739
US

IV. Provider business mailing address

URB. CAMINO SERENO CALLE 3 F22
LAS PIEDRAS PR
00771
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8182
  • Fax:
Mailing address:
  • Phone: 787-309-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13554
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier13554
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerLICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: