Healthcare Provider Details

I. General information

NPI: 1093999823
Provider Name (Legal Business Name): JUAN A RIVERA-ALICEA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 05/06/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 156 BO. RIO HONDO URB SABANA DEL PALMAR
COMERIO PR
00782
US

IV. Provider business mailing address

CARR. 156 BO. RIO HONDO URB SABANA DEL PALMAR
COMERIO PR
00782
US

V. Phone/Fax

Practice location:
  • Phone: 939-280-7455
  • Fax:
Mailing address:
  • Phone: 939-280-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1823
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number115791
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2891
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: