Provider Demographics
NPI:1891194460
Name:RIVERA, JESSICA ROCIO (LMFT #100623)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROCIO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMFT #100623
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 HARMONY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-2055
Mailing Address - Country:US
Mailing Address - Phone:760-846-4427
Mailing Address - Fax:
Practice Address - Street 1:2346 HARMONY GROVE RD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-2055
Practice Address - Country:US
Practice Address - Phone:760-846-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist