Provider Demographics
NPI:1568816551
Name:RIVERA, ISTRA (LCSW)
Entity Type:Individual
Prefix:
First Name:ISTRA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 TIFFANY BLVD
Mailing Address - Street 2:APT 332
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2458
Mailing Address - Country:US
Mailing Address - Phone:201-208-5760
Mailing Address - Fax:
Practice Address - Street 1:136 TIFFANY BLVD
Practice Address - Street 2:APT 332
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2458
Practice Address - Country:US
Practice Address - Phone:201-208-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046732001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical