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General NPI Number Information
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NPI Number | 1316835762
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Entity Type | Individual
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Provider Name | MIRIAM IVETTE CENTENO RIVERA LSWC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | VALLE SERENO CALLE LUNA B-6
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City | JUANA DIAZ
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State | PR
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Zip | 00795-9324
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Country | US
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Telephone | 787-988-9107
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Fax |
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Provider Business Mailing Address
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Address Line | VALLE SERENO #32 CALLE AMOR
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City | JUANA DIAZ
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State | PR
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Zip | 00795
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Country | US
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Telephone | 787-988-9107
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11810
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License Number State | PR
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