Provider Demographics
NPI:1184285223
Name:RIVERA, MOLLY ELISABETH (ATR-BC, LPC)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ELISABETH
Last Name:RIVERA
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:NICHOLSON
Mailing Address - State:PA
Mailing Address - Zip Code:18446-0548
Mailing Address - Country:US
Mailing Address - Phone:570-878-3722
Mailing Address - Fax:
Practice Address - Street 1:96 STATE ST
Practice Address - Street 2:
Practice Address - City:NICHOLSON
Practice Address - State:PA
Practice Address - Zip Code:18446-8207
Practice Address - Country:US
Practice Address - Phone:570-604-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional