Provider Demographics
NPI:1376110528
Name:RIVERA, ALFREDO JR (MA)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 PAESANOS PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1266
Mailing Address - Country:US
Mailing Address - Phone:210-481-4265
Mailing Address - Fax:210-851-8374
Practice Address - Street 1:3519 PAESANOS PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1266
Practice Address - Country:US
Practice Address - Phone:210-481-4265
Practice Address - Fax:210-851-8374
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2022-06-03
Deactivation Date:2022-05-04
Deactivation Code:
Reactivation Date:2022-06-03
Provider Licenses
StateLicense IDTaxonomies
TX77106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77106OtherTEXAS STATE BOARD OF LICENSED PROFESSIONAL COUNSELORS