Provider Demographics
NPI:1477278778
Name:RIVERA, NAIDA (CAC)
Entity Type:Individual
Prefix:
First Name:NAIDA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KENYON PL
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2325
Mailing Address - Country:US
Mailing Address - Phone:860-794-1209
Mailing Address - Fax:
Practice Address - Street 1:97 SOUTH ST STE 105
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1964
Practice Address - Country:US
Practice Address - Phone:860-461-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT45.000765101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)