Provider Demographics
NPI:1457673139
Name:RIVERS, JEROME C (LPCC-S, LIMFT)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:C
Last Name:RIVERS
Suffix:
Gender:M
Credentials:LPCC-S, LIMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281081
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-8181
Mailing Address - Country:US
Mailing Address - Phone:216-475-2112
Mailing Address - Fax:216-475-2120
Practice Address - Street 1:4582 LEE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3759
Practice Address - Country:US
Practice Address - Phone:216-475-2112
Practice Address - Fax:216-475-2120
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004292101YP2500X
OHF0000120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional