Provider Demographics
NPI:1245452648
Name:RIVERA RIOLLANO, IVETTE D (PSY D)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:D
Last Name:RIVERA RIOLLANO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:IVETTE
Other - Middle Name:D
Other - Last Name:RIVERA RIOLLANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D
Mailing Address - Street 1:PO BOX 1974
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1974
Mailing Address - Country:US
Mailing Address - Phone:787-367-7279
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 84.7
Practice Address - Street 2:URB ALTURAS DE HATILLO ESQUINA JARDIN
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-367-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1699103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1974OtherPSICOLOGA