Provider Demographics
NPI:1326494089
Name:RIVERA, LYNETTE
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2149
Mailing Address - Country:US
Mailing Address - Phone:617-617-7424
Mailing Address - Fax:617-514-7263
Practice Address - Street 1:1059 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120-2149
Practice Address - Country:US
Practice Address - Phone:617-445-4075
Practice Address - Fax:617-742-4354
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor