Healthcare Provider Details

I. General information

NPI: 1629793542
Provider Name (Legal Business Name): ALNELIE M RIVERA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 152 KM 5 HT 9
NARANJITO PR
00719
US

IV. Provider business mailing address

HC 72 BOX 3376
NARANJITO PR
00719-8701
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-3230
  • Fax:
Mailing address:
  • Phone: 787-460-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number3650
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3650
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3650
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: