Provider Demographics
NPI:1235884560
Name:RIVERA, CECILIA YASMINE (LCSW)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:YASMINE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2718
Mailing Address - Country:US
Mailing Address - Phone:815-557-1584
Mailing Address - Fax:
Practice Address - Street 1:822 HILLGROVE AVE STE 2
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1474
Practice Address - Country:US
Practice Address - Phone:872-254-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0242391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical