Healthcare Provider Details

I. General information

NPI: 1467931436
Provider Name (Legal Business Name): MICHELLE CRUZ RIVERA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DEL CARMEN #55
FAJARDO PR
00738
US

IV. Provider business mailing address

55 CALLE DEL CARMEN W
FAJARDO PR
00738-4717
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-3558
  • Fax:
Mailing address:
  • Phone: 787-455-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13482
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: