Provider Demographics
NPI:1689097537
Name:RIVERA, JOSE (PASTORAL COUNSELOR)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 OLD PHILADELPHIA PIKE
Mailing Address - Street 2:STARLITE DRIVEUNIT C
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602
Mailing Address - Country:US
Mailing Address - Phone:717-661-7636
Mailing Address - Fax:717-826-5485
Practice Address - Street 1:2325 OLD PHILADELPHIA PIKE
Practice Address - Street 2:STARLITE DRIVEUNIT C
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3441
Practice Address - Country:US
Practice Address - Phone:717-661-7636
Practice Address - Fax:717-826-5485
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral