Provider Demographics
NPI:1881387124
Name:RIVERA, OMAIRA MARISELA (MSW)
Entity type:Individual
Prefix:MISS
First Name:OMAIRA
Middle Name:MARISELA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:OMAIRA
Other - Middle Name:MARISELA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0871
Mailing Address - Country:US
Mailing Address - Phone:787-520-7157
Mailing Address - Fax:
Practice Address - Street 1:CALLE SGTO. GERARDO SANTIAGO #55 INTERIOR
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-520-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical