Provider Demographics
NPI:1114003225
Name:RIVERA, CARMEN IVETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:IVETTE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4004
Mailing Address - Country:US
Mailing Address - Phone:516-754-3332
Mailing Address - Fax:516-221-4709
Practice Address - Street 1:3375 PARK AVE STE 4000
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3799
Practice Address - Country:US
Practice Address - Phone:516-754-3332
Practice Address - Fax:516-221-4709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0711951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical