Provider Demographics
NPI:1740750843
Name:RIVERA, NOE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:NOE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2121
Mailing Address - Street 2:
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91706-1085
Mailing Address - Country:US
Mailing Address - Phone:626-600-1161
Mailing Address - Fax:
Practice Address - Street 1:100 W FOOTHILL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1170
Practice Address - Country:US
Practice Address - Phone:626-602-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist