Provider Demographics
NPI:1124184395
Name:RIVERA, ADRIAN MARC (LCSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:MARC
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2585
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-6585
Mailing Address - Country:US
Mailing Address - Phone:978-938-9017
Mailing Address - Fax:
Practice Address - Street 1:179 GREAT RD STE 102
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5740
Practice Address - Country:US
Practice Address - Phone:978-938-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 259091041C0700X
MA1239081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical