Provider Demographics
NPI:1265791479
Name:RIVERA, DANIEL E
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ROSLAND DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4804
Mailing Address - Country:US
Mailing Address - Phone:413-364-0035
Mailing Address - Fax:
Practice Address - Street 1:230 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5144
Practice Address - Country:US
Practice Address - Phone:413-322-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1307576Medicaid
MA1303295Medicaid
MAM18463OtherBLUE CROSS/BLUE SHIELD
MA1303295Medicaid