Provider Demographics
NPI:1487178778
Name:RIVERA, CHERYL MADELL (LMFT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MADELL
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 PRADO ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-3021
Mailing Address - Country:US
Mailing Address - Phone:210-393-0452
Mailing Address - Fax:
Practice Address - Street 1:1401 DEZARAE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5840
Practice Address - Country:US
Practice Address - Phone:210-727-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist