Healthcare Provider Details

I. General information

NPI: 1548573298
Provider Name (Legal Business Name): YESENIA RIVERA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 CALLE CARAZO OFICINA 2D
GUAYNABO PR
00969-5603
US

IV. Provider business mailing address

PO BOX 1676
GUAYNABO PR
00970-1676
US

V. Phone/Fax

Practice location:
  • Phone: 787-615-0782
  • Fax:
Mailing address:
  • Phone: 787-731-6966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4185
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4185
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4185
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4185
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: