=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043130479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIZ NELLY RIVERA MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2026
-----------------------------------------------------
Last Update Date | 07/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PR #2 KM 159.0 AVENIDA HOSTOS 826 EDIFICIO VILLA CAPITAN III SUITE 101
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-499-5888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | B4 CALLE 5
-----------------------------------------------------
City | CABO ROJO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00623-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-349-9159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 8257
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------