Provider Demographics
NPI:1609538172
Name:RIVERA, LASANDRA JEANE' (MSW)
Entity Type:Individual
Prefix:
First Name:LASANDRA
Middle Name:JEANE'
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E JUDAH DR APT B
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3450
Mailing Address - Country:US
Mailing Address - Phone:504-717-5568
Mailing Address - Fax:
Practice Address - Street 1:1525 E JUDAH DR APT B
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3450
Practice Address - Country:US
Practice Address - Phone:504-717-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical