Provider Demographics
NPI:1750307427
Name:RIVERA, ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3339
Mailing Address - Country:US
Mailing Address - Phone:410-282-7222
Mailing Address - Fax:410-282-0069
Practice Address - Street 1:7827 WISE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-3339
Practice Address - Country:US
Practice Address - Phone:410-282-7222
Practice Address - Fax:410-282-0069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03845103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD436LG354Medicare PIN