Provider Demographics
NPI:1275092504
Name:RIVERA, RICHARD (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 COVE RD
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-2755
Mailing Address - Country:US
Mailing Address - Phone:856-524-1215
Mailing Address - Fax:
Practice Address - Street 1:7999 N ROUTE 130
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1402
Practice Address - Country:US
Practice Address - Phone:856-320-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical