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General NPI Number Information
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NPI Number | 1982761169
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Entity Type | Organization
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Legal Business Name | NILSA RIVERA PHD PA
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 692 GOODLETTE RD N
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City | NAPLES
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State | FL
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Zip | 34102
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Country | US
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Telephone | 239-434-2425
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Fax | 239-649-6085
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Provider Business Mailing Address
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Address Line | 692 GOODLETTE RD N
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City | NAPLES
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State | FL
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Zip | 34102
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Country | US
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Telephone | 239-434-2425
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Fax | 239-649-6085
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NILSA RIVERA
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Credential | PHD
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Telephone | 239-434-2425
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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 | PY6994
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License Number State | FL
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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 | PY6994
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY6994
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License Number State | FL
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