Provider Demographics
NPI:1760100465
Name:RIVERO, ERIKA (LSMW-17483)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:RIVERO
Suffix:
Gender:F
Credentials:LSMW-17483
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W SOUTHERN AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5022
Mailing Address - Country:US
Mailing Address - Phone:480-962-9288
Mailing Address - Fax:
Practice Address - Street 1:623 W SOUTHERN AVE STE 7
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5022
Practice Address - Country:US
Practice Address - Phone:480-962-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLSMW-17483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health