Provider Demographics
NPI:1093217259
Name:RIVERA, NOEMI (LPC)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EDGAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-2318
Mailing Address - Country:US
Mailing Address - Phone:203-442-4320
Mailing Address - Fax:
Practice Address - Street 1:1 COLONY ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-3210
Practice Address - Country:US
Practice Address - Phone:203-440-4622
Practice Address - Fax:203-440-4625
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.003386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional