Provider Demographics
NPI:1609621325
Name:RIVERA, RAFAEL
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:RIVERA
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 1:155 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 W PARK ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-1714
Practice Address - Country:US
Practice Address - Phone:413-717-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician