Provider Demographics
NPI:1518260298
Name:RIVERA, IRMA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:IRMA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 GOUVERNEUR AVE
Mailing Address - Street 2:APT. 4K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2904
Mailing Address - Country:US
Mailing Address - Phone:917-612-4593
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1268
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-987-7214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health