=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316389471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCYANN BERNIER-RIVERA PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2013
-----------------------------------------------------
Last Update Date | 06/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CENTRO INTERNACIONAL DE MERCADEO TORRE I CARR 165 SUITE 401
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00968-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-900-1888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9295
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00726-9295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-900-1888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 5181
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------