Provider Demographics
NPI:1801816434
Name:RIVERA, PATRICIA A (LISW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 FORRESTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1907
Mailing Address - Country:US
Mailing Address - Phone:505-917-8904
Mailing Address - Fax:
Practice Address - Street 1:1710 CENTRO FAMILIAR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-0001
Practice Address - Country:US
Practice Address - Phone:505-212-7399
Practice Address - Fax:505-877-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-2541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00071004Medicaid