Provider Demographics
NPI:1528380359
Name:RIVERA, NELSON RAYMOND (LCSW)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:RAYMOND
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 N PINE ISLAND RD APT C302
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1832
Mailing Address - Country:US
Mailing Address - Phone:954-495-3188
Mailing Address - Fax:
Practice Address - Street 1:2333 ONTARIO RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2627
Practice Address - Country:US
Practice Address - Phone:202-483-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0668591041C0700X
FLSW111191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical