| NPI | 1659618338 |
|---|---|
| Former Name | MICHELLE SUZANNE RIVERA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 36131) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36131) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 36131) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 36131) | |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2019-01-14 |