Provider Demographics
NPI:1710770789
Name:RIVERA OCASIO, KEYSHLA MARIE (MS)
Entity type:Individual
Prefix:MRS
First Name:KEYSHLA
Middle Name:MARIE
Last Name:RIVERA OCASIO
Suffix:
Gender:F
Credentials:MS
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 3634
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-3634
Mailing Address - Country:US
Mailing Address - Phone:787-213-2711
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA 10- A VEGA ALTA PUERTO RICO
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6517646103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling