Provider Demographics
NPI:1659650265
Name:RIVERA, MELISSA RAQUEL (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:RAQUEL
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:M. RAQUEL
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:461 N EUCLID AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1382
Mailing Address - Country:US
Mailing Address - Phone:626-421-2360
Mailing Address - Fax:626-888-4009
Practice Address - Street 1:1214 E COLORADO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1899
Practice Address - Country:US
Practice Address - Phone:626-421-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist