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General NPI Number Information
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NPI Number | 1104339043
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Entity Type | Individual
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Provider Name | JORGE ENRIQUE RIVERA LPC
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Gender | Male
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 304 ROOSEVELT CALLE SOLDADO HECTOR SALAMAN
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City | SAN JUAN
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State | PR
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Zip | 00918-2348
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Country | US
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Telephone | 787-377-3584
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Fax |
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Provider Business Mailing Address
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Address Line | 20 NARRAGANSETT ST APT 1
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1776
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Country | US
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Telephone | 787-377-3584
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Fax | 413-363-2319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3747
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6419
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6419
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2620
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License Number State | PR
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