Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 192 | PR |
N | 103TC1900X | Counseling Psychologist | 978 | PR |
NPI | 1205046976 |
---|---|
Provider Name | Mrs. Wanda Yadira Rivera |
First Address | Bayamon, PR 00960-0186 |
Second Address | Hato Rey, PR 00917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |