Provider Demographics
NPI:1609510098
Name:RIVERA ROMAN, MIGUEL RODRIGO
Entity Type:Individual
Prefix:
First Name:MIGUEL RODRIGO
Middle Name:
Last Name:RIVERA ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-2509
Mailing Address - Country:US
Mailing Address - Phone:413-296-6185
Mailing Address - Fax:413-455-2990
Practice Address - Street 1:480 WILLIAM F MCCLELLAN HWY STE 302
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1389
Practice Address - Country:US
Practice Address - Phone:857-264-0965
Practice Address - Fax:413-455-2990
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor