Provider Demographics
NPI:1457474066
Name:RIVERA, ENID CELESTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ENID
Middle Name:CELESTE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 PRESIDENT ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1178
Mailing Address - Country:US
Mailing Address - Phone:917-536-6767
Mailing Address - Fax:
Practice Address - Street 1:85 5TH AVE STE 921
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3019
Practice Address - Country:US
Practice Address - Phone:917-536-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2685103TC0700X
NY017161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical