Provider Demographics
NPI:1053737254
Name:AVILES-OLIVO, YANIRA (MMHC)
Entity type:Individual
Prefix:
First Name:YANIRA
Middle Name:
Last Name:AVILES-OLIVO
Suffix:
Gender:F
Credentials:MMHC
Other - Prefix:
Other - First Name:YANIRA
Other - Middle Name:
Other - Last Name:AVILES-OLIVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:AVENIDA ROBERTO CLEMENTE
Mailing Address - Street 2:132 #13 VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00985
Mailing Address - Country:UM
Mailing Address - Phone:787-925-1465
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA ROBERTO CLEMENTE
Practice Address - Street 2:132 #13 VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-925-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health