Healthcare Provider Details

I. General information

NPI: 1114540754
Provider Name (Legal Business Name): JESENIA FONSECA RIVERA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 63 BOX 3939
PATILLAS PR
00723-9648
US

IV. Provider business mailing address

STREET CORNER 46
ARROYO PR
00714
US

V. Phone/Fax

Practice location:
  • Phone: 939-280-8833
  • Fax:
Mailing address:
  • Phone: 787-839-4150
  • Fax: 787-839-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11002
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: