Provider Demographics
NPI:1164269932
Name:ALICEA RIVERA, PAOLA ALEJANDRA
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:ALEJANDRA
Last Name:ALICEA RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 44352
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9628
Mailing Address - Country:US
Mailing Address - Phone:787-988-2218
Mailing Address - Fax:
Practice Address - Street 1:AVE LUIS MUNOZ MARIN
Practice Address - Street 2:ESQ CALLE 12 J-1 URB SANTA JUANA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-980-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7907103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling