Provider Demographics
NPI:1437684644
Name:RIVERA, ADELE (NONE)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3855
Mailing Address - Country:US
Mailing Address - Phone:914-968-7848
Mailing Address - Fax:914-968-7848
Practice Address - Street 1:143 BRUCE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3855
Practice Address - Country:US
Practice Address - Phone:914-968-7848
Practice Address - Fax:914-968-7848
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32.014.7865Medicaid