Provider Demographics
NPI:1184064412
Name:RIVERA, BRANDY
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:RIVERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6739 FLORA AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-3540
Mailing Address - Country:US
Mailing Address - Phone:253-223-0073
Mailing Address - Fax:
Practice Address - Street 1:1902 2ND AVE STE 208
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1186
Practice Address - Country:US
Practice Address - Phone:206-956-9570
Practice Address - Fax:206-448-8495
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 1041C0700X
WAMA 60191640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 60191640OtherMASSAGE PRACTITIONER LICENSE