Provider Demographics
NPI:1962396275
Name:RIVERA SEPULVEDA, VICMARIE
Entity type:Individual
Prefix:MRS
First Name:VICMARIE
Middle Name:
Last Name:RIVERA SEPULVEDA
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 1:120 VIA DEL SOL
Mailing Address - Street 2:URB. VALLE SAN LUIS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-557-7833
Mailing Address - Fax:
Practice Address - Street 1:120 VIA DEL SOL
Practice Address - Street 2:URB. VALLE SAN LUIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-557-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4712101YS0200X
PR4712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool