Provider Demographics
NPI:1518470194
Name:RIVERA, PETER M (PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20618 142ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3066
Mailing Address - Country:US
Mailing Address - Phone:206-851-1718
Mailing Address - Fax:
Practice Address - Street 1:3307 3RD AVE W STE 120
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-1922
Practice Address - Country:US
Practice Address - Phone:206-851-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60695942106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604183681OtherUBI