Provider Demographics
NPI:1376767830
Name:RIVERA-VEGA, ADALBERTO (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ADALBERTO
Middle Name:
Last Name:RIVERA-VEGA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-6816
Mailing Address - Country:US
Mailing Address - Phone:978-407-4688
Mailing Address - Fax:
Practice Address - Street 1:403 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1019
Practice Address - Country:US
Practice Address - Phone:413-588-7739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1026399104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20559Medicare ID - Type UnspecifiedPROVIDER ID