Provider Demographics
NPI:1619281664
Name:RIVERA, RAEANN (LCSW)
Entity Type:Individual
Prefix:
First Name:RAEANN
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 ALHAMBRA AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1601
Mailing Address - Country:US
Mailing Address - Phone:575-208-4662
Mailing Address - Fax:505-212-0976
Practice Address - Street 1:2109 ALHAMBRA AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1601
Practice Address - Country:US
Practice Address - Phone:575-208-4662
Practice Address - Fax:505-212-0976
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-096091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical