Provider Demographics
NPI:1114442407
Name:RIVERA, ANNA V (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:V
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3615 OXFORD AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1791
Mailing Address - Country:US
Mailing Address - Phone:646-242-0948
Mailing Address - Fax:
Practice Address - Street 1:3615 OXFORD AVE APT 13
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1791
Practice Address - Country:US
Practice Address - Phone:646-242-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-23016103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst