Provider Demographics
NPI:1235336496
Name:RIVERA, GAIL A (LMSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 HILL DR
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1312
Mailing Address - Country:US
Mailing Address - Phone:631-567-9037
Mailing Address - Fax:
Practice Address - Street 1:595 ROUTE 25A STE 20
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2647
Practice Address - Country:US
Practice Address - Phone:631-744-5500
Practice Address - Fax:631-744-5677
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062726104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker