Provider Demographics
NPI:1619371382
Name:RIVERA, LUIS A JR
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:RIVERA
Suffix:JR
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 1:9 HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:856-358-4120
Practice Address - Street 1:9 HARDING HWY
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318-4401
Practice Address - Country:US
Practice Address - Phone:856-358-4111
Practice Address - Fax:856-358-4120
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst