Provider Demographics
NPI:1366792475
Name:RIVERA VIDAL, YOLIANN (MSW)
Entity type:Individual
Prefix:
First Name:YOLIANN
Middle Name:
Last Name:RIVERA VIDAL
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:CAFETAL SHOPP CTR
Mailing Address - Street 2:CALLE 13 I-135
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3469
Mailing Address - Country:US
Mailing Address - Phone:787-602-9843
Mailing Address - Fax:
Practice Address - Street 1:CAFETAL SHOPP CTR
Practice Address - Street 2:CALLE 13 I 135
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3469
Practice Address - Country:US
Practice Address - Phone:787-602-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR47946051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4794605OtherLICENCIA CONDUCIR