Healthcare Provider Details

I. General information

NPI: 1932064219
Provider Name (Legal Business Name): LARRISSA LORAINE RIVERA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. EL PEDREGAL CALLE LAJAS 147
SAN GERMAN PR
00683
US

IV. Provider business mailing address

URB. EL PEDREGAL CALLE LAJAS 147
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-659-3136
  • Fax:
Mailing address:
  • Phone: 787-659-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8533
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: