Provider Demographics
NPI:1184959884
Name:RIVERA-DEL VALLE, JUAN-DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:JUAN-DAVID
Middle Name:
Last Name:RIVERA-DEL VALLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3989 50TH ST APT 3K
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3104
Mailing Address - Country:US
Mailing Address - Phone:917-224-6789
Mailing Address - Fax:
Practice Address - Street 1:3989 50TH ST APT 3K
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3104
Practice Address - Country:US
Practice Address - Phone:917-224-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08267011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical