Provider Demographics
NPI:1467664565
Name:RIVERA, EVELYN TERESA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:TERESA
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 1:5805 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-1602
Mailing Address - Country:US
Mailing Address - Phone:216-965-5049
Mailing Address - Fax:
Practice Address - Street 1:7800 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2814
Practice Address - Country:US
Practice Address - Phone:216-965-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist