Provider Demographics
NPI:1447476403
Name:MATOS RIVERA, IRIS A (MSW)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:A
Last Name:MATOS RIVERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND PARQUE ARCOIRIS
Mailing Address - Street 2:227 CALLE 2 APT 158
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2855
Mailing Address - Country:US
Mailing Address - Phone:787-367-3345
Mailing Address - Fax:
Practice Address - Street 1:227 CALLE 2 APT 158
Practice Address - Street 2:COND PARQUE ARCOIRIS
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2855
Practice Address - Country:US
Practice Address - Phone:787-367-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker