Provider Demographics
NPI:1790975696
Name:RIVERA, NANCY J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JOANNA
Other - Last Name:PADRON-RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4040 79TH ST APT C105
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1134
Mailing Address - Country:US
Mailing Address - Phone:718-440-2041
Mailing Address - Fax:
Practice Address - Street 1:4040 79TH ST APT C105
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1134
Practice Address - Country:US
Practice Address - Phone:718-440-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094482104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker