Provider Demographics
NPI:1609178813
Name:CARMEN M RIVERA, LCSW
Entity Type:Organization
Organization Name:CARMEN M RIVERA, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MILAGROS
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:302-981-0912
Mailing Address - Street 1:104 FULTON AVE
Mailing Address - Street 2:CHILD MED GRP
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2808
Mailing Address - Country:US
Mailing Address - Phone:302-981-0912
Mailing Address - Fax:845-765-2489
Practice Address - Street 1:104 FULTON AVE
Practice Address - Street 2:CHILD MED GRP
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2808
Practice Address - Country:US
Practice Address - Phone:302-981-0912
Practice Address - Fax:845-765-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0784051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty