Provider Demographics
NPI:1831484674
Name:RIVERA, TERESA (LCSW 77388)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW 77388
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S HILL ST # 6TH
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3506
Mailing Address - Country:US
Mailing Address - Phone:213-332-4589
Mailing Address - Fax:
Practice Address - Street 1:222 S HILL ST FL 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3523
Practice Address - Country:US
Practice Address - Phone:213-332-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA773881041C0700X
CALCSW773881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical