Provider Demographics
NPI:1578944112
Name:RIVERA-MORALES, CAMILA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMILA
Middle Name:M
Last Name:RIVERA-MORALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5325
Mailing Address - Country:US
Mailing Address - Phone:212-206-5200
Mailing Address - Fax:
Practice Address - Street 1:635 W 165TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3724
Practice Address - Country:US
Practice Address - Phone:212-305-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025007OtherLICENSE