Provider Demographics
NPI:1609129790
Name:RIVERA, EUGENE (MSW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LAUREL CREST RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3344
Mailing Address - Country:US
Mailing Address - Phone:203-245-3467
Mailing Address - Fax:
Practice Address - Street 1:20 LAUREL CREST RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3344
Practice Address - Country:US
Practice Address - Phone:203-245-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0037471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical