Individual provider Active NPI

Suzette Rivera, PSY.D

  • Clinical Psychologist
  • San Juan, PR
National Provider Identifier
1548855224
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6889 Issued in PR
Practice address
400 Ave Domenech Ste 509
San Juan, PR 00918-3705
Phone
(787) 998-1297
NPI assigned
Mar 4, 2021
Last updated
Mar 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6889 PR Primary

Addresses

Primary practice location

400 Ave Domenech Ste 509
San Juan, PR 00918-3705

Mailing address

400 Ave Domenech Ste 509
San Juan, PR 00918-3705
Phone (787) 998-1297

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250125000052 PR Practitioner - Clinical Psychologist 3375072002 Practice locations: San Juan, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rivera Emotional Health Center, LLC Clinical CurrentSince Nov 28, 2021 Accepting new patients

Locations

400 Ave Domenech
Ste 509
San Juan, PR 00918
Phone (787) 365-3352

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1548855224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 AVE DOMENECH STE 509",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009183705",
            "telephone_number": "787-998-1297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 AVE DOMENECH STE 509",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009183705",
            "telephone_number": "787-998-1297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "SUZETTE",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "6889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.