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General NPI Number Information
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NPI Number | 1154019149
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Entity Type | Individual
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Provider Name | JACKELINE CARABALLO RIVERA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | URB COCOBEACH 210 CALLE MANATI
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City | RIO GRANDE
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State | PR
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Zip | 00745
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Country | US
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Telephone | 787-516-6607
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Fax |
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Provider Business Mailing Address
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Address Line | URB COCOBEACH 210 CALLE MANATI CALLE MANATI
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City | RIO GRANDE
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State | PR
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Zip | 00745
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Country | US
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Telephone | 787-516-6607
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Fax |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6187
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6187
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License Number State | PR
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