Provider Demographics
NPI:1639870934
Name:GUTIERREZ RIVERA, NICOLE MARIE (MASTER DEGREE)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:GUTIERREZ RIVERA
Suffix:
Gender:F
Credentials:MASTER DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 CALLE SAN MATEO
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-8634
Mailing Address - Country:US
Mailing Address - Phone:787-478-9314
Mailing Address - Fax:
Practice Address - Street 1:10 CASIA STREET
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16188104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker