Provider Demographics
NPI:1013581016
Name:RIVERA, NANCY E (LMFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W. IMPERIAL HWY.
Mailing Address - Street 2:SUTE E #160
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631
Mailing Address - Country:US
Mailing Address - Phone:657-204-6381
Mailing Address - Fax:
Practice Address - Street 1:22600 SAVI RANCH PKWY # A-38
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-4606
Practice Address - Country:US
Practice Address - Phone:657-204-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA84-3492093OtherIRS