Provider Demographics
NPI:1871670919
Name:RIVERA, RICK EUGENIO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:EUGENIO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 ELLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4521
Mailing Address - Country:US
Mailing Address - Phone:732-457-9703
Mailing Address - Fax:
Practice Address - Street 1:808 ELLIS PKWY
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4521
Practice Address - Country:US
Practice Address - Phone:732-457-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000150001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical