Provider Demographics
NPI:1104397017
Name:RIVAS ORELLANA, AMY FABIOLA
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:FABIOLA
Last Name:RIVAS ORELLANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE STE 1909
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3626
Mailing Address - Country:US
Mailing Address - Phone:773-362-6222
Mailing Address - Fax:773-362-6222
Practice Address - Street 1:30 N MICHIGAN AVE STE 1909
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3626
Practice Address - Country:US
Practice Address - Phone:773-362-6222
Practice Address - Fax:773-362-6222
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor