Provider Demographics
NPI:1639334147
Name:RIVERA, MAGALI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAGALI
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 1:998 CROOKED HILL ROAD
Mailing Address - Street 2:PPC/CSD/BUCKMAN CENTER/LA CASITA BLDG.#47
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1087
Mailing Address - Country:US
Mailing Address - Phone:631-805-6547
Mailing Address - Fax:
Practice Address - Street 1:998 CROOKED HILL ROAD
Practice Address - Street 2:PPC/CSD/BUCKMAN CENTER/LA CASITA BLDG.#47
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1087
Practice Address - Country:US
Practice Address - Phone:631-805-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072407-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical