Provider Demographics
NPI:1578346854
Name:TENEMEA RIVAS, JALINE A (LSW)
Entity Type:Individual
Prefix:
First Name:JALINE
Middle Name:A
Last Name:TENEMEA RIVAS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 KOSSUTH ST # 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3313
Mailing Address - Country:US
Mailing Address - Phone:973-704-6192
Mailing Address - Fax:
Practice Address - Street 1:315 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1383
Practice Address - Country:US
Practice Address - Phone:908-344-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06816300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker