Provider Demographics
NPI:1639506124
Name:RIVERA, DAISY MARIELA (PSYD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:MARIELA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:DR
Other - First Name:DAISY
Other - Middle Name:MARIELA
Other - Last Name:WAUKAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 SKYLINE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-6122
Mailing Address - Country:US
Mailing Address - Phone:509-387-3182
Mailing Address - Fax:509-664-4590
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-477-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60748230101YM0800X
390200000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2085250Medicaid