Provider Demographics
NPI:1861864688
Name:RIVERA, DAVID (BS, CASAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:BS, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2866
Mailing Address - Country:US
Mailing Address - Phone:212-289-1788
Mailing Address - Fax:212-289-2430
Practice Address - Street 1:1795 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2866
Practice Address - Country:US
Practice Address - Phone:212-289-1788
Practice Address - Fax:212-289-2430
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20817101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)