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General NPI Number Information
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NPI Number | 1245501766
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Entity Type | Individual
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Provider Name | ELIZABETH CARLO RIVERA PHD IN CL PSYCH
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Gender | Female
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | POLICLINICA BELLA VISTA 770 AVE HOSTOS OFIC 302
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City | MAYAGUEZ
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State | PR
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Zip | 00682
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Country | US
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Telephone | 787-384-1795
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Fax | 787-834-9597
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Provider Business Mailing Address
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Address Line | 4 C-26 REPARTO ANAIDA
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City | PONCE
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State | PR
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Zip | 00716-2534
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Country | US
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Telephone | 787-384-1795
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Fax | 787-834-9597
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3434
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License Number State | PR
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