Provider Demographics
NPI:1518111921
Name:RIVERA, CANDITA (CASAC)
Entity Type:Individual
Prefix:MS
First Name:CANDITA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3334
Mailing Address - Country:US
Mailing Address - Phone:845-331-1448
Mailing Address - Fax:845-334-8590
Practice Address - Street 1:26 GROVE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3334
Practice Address - Country:US
Practice Address - Phone:845-331-1448
Practice Address - Fax:845-334-8590
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21169101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)