Provider Demographics
NPI:1942534185
Name:RIVERA, CARMEN (CADCII)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 LARK AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2564
Mailing Address - Country:US
Mailing Address - Phone:650-770-7831
Mailing Address - Fax:
Practice Address - Street 1:950 W JULIAN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2719
Practice Address - Country:US
Practice Address - Phone:408-292-9353
Practice Address - Fax:408-287-3104
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS3673101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool