Provider Demographics
NPI:1700624459
Name:RIVERA BERRIOS, ISMARILIS (MSW CLINICAL)
Entity type:Individual
Prefix:MRS
First Name:ISMARILIS
Middle Name:
Last Name:RIVERA BERRIOS
Suffix:
Gender:F
Credentials:MSW CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1683
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1683
Mailing Address - Country:US
Mailing Address - Phone:787-231-0690
Mailing Address - Fax:
Practice Address - Street 1:CARR. 149 #5 BO. PESAS
Practice Address - Street 2:
Practice Address - City:PR
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-231-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR168911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical