Provider Demographics
NPI:1265528020
Name:RIVERA, AMARILIS (LCSW)
Entity type:Individual
Prefix:
First Name:AMARILIS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ADAMS ST
Mailing Address - Street 2:10J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1850
Mailing Address - Country:US
Mailing Address - Phone:516-532-8395
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:2700
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:516-532-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR021571-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN60941Medicare ID - Type Unspecified