Provider Demographics
NPI:1255999702
Name:RIVERA, CLARICE ELIZABETH
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:ELIZABETH
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3224
Mailing Address - Country:US
Mailing Address - Phone:413-237-8545
Mailing Address - Fax:413-773-0477
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3224
Practice Address - Country:US
Practice Address - Phone:413-237-8545
Practice Address - Fax:413-773-0477
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist