Healthcare Provider Details

I. General information

NPI: 1255295291
Provider Name (Legal Business Name): GRETCHEN CABALLER RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713A PASEO LA COLONIA
PONCE PR
00717-2234
US

IV. Provider business mailing address

PO BOX 8356
PONCE PR
00732-8356
US

V. Phone/Fax

Practice location:
  • Phone: 939-422-0147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8655
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: