Healthcare Provider Details

I. General information

NPI: 1174466262
Provider Name (Legal Business Name): BERAINE NICOLE RIVERA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. INDUSTRIAL, CARR. 64 ESQUINA, CALLE 3
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 731
MAYAGUEZ PR
00681-0731
US

V. Phone/Fax

Practice location:
  • Phone: 787-360-9952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7245
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: