Provider Demographics
NPI:1225644883
Name:RIVERA, RICARDO DESHAWN (LMSW)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:DESHAWN
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 BELCREST RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2010
Mailing Address - Country:US
Mailing Address - Phone:862-237-8738
Mailing Address - Fax:
Practice Address - Street 1:6515 BELCREST RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2010
Practice Address - Country:US
Practice Address - Phone:862-237-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25865104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker