Provider Demographics
NPI:1265142681
Name:RIVERA, LETTICIA
Entity type:Individual
Prefix:
First Name:LETTICIA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LETTICIA
Other - Middle Name:
Other - Last Name:ROSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:548 THROGGS NECK EXPY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1717
Mailing Address - Country:US
Mailing Address - Phone:646-820-8167
Mailing Address - Fax:
Practice Address - Street 1:1085 GERARD AVE APT 1C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8870
Practice Address - Country:US
Practice Address - Phone:347-398-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113949-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker