Provider Demographics
NPI:1891064796
Name:RIVERA, AIDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3007
Mailing Address - Country:US
Mailing Address - Phone:631-524-1323
Mailing Address - Fax:
Practice Address - Street 1:445 OAK ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-3111
Practice Address - Country:US
Practice Address - Phone:631-257-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health