Provider Demographics
NPI:1447917315
Name:RIVERA TORRES, KIARAMIL
Entity type:Individual
Prefix:
First Name:KIARAMIL
Middle Name:
Last Name:RIVERA TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 CALLE YAGRUMO
Mailing Address - Street 2:URB FAJARDO GARDENS
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:939-460-0428
Mailing Address - Fax:
Practice Address - Street 1:228 CALLE YAGRUMO
Practice Address - Street 2:URB FAJARDO GARDENS
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:939-460-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22375104100000X
PR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22375OtherSOCIAL WORKER