Provider Demographics
NPI:1720365513
Name:RIVERA, JENNY REBECCA (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:REBECCA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 GRANADA
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4540
Mailing Address - Country:US
Mailing Address - Phone:956-345-6201
Mailing Address - Fax:956-969-8704
Practice Address - Street 1:2629 GRANADA
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4540
Practice Address - Country:US
Practice Address - Phone:956-345-6201
Practice Address - Fax:956-969-8704
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37815104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker