Provider Demographics
NPI:1114658077
Name:RIVERA, SAMANTHA KAY
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAY
Last Name:RIVERA
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 1:225 MARGARET AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3081
Mailing Address - Country:US
Mailing Address - Phone:724-522-5456
Mailing Address - Fax:
Practice Address - Street 1:225 MARGARET AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3081
Practice Address - Country:US
Practice Address - Phone:724-522-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor