Provider Demographics
NPI:1356794184
Name:RIVERA, DANA (LPC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 N AVONDALE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1572
Mailing Address - Country:US
Mailing Address - Phone:773-774-4444
Mailing Address - Fax:773-774-4447
Practice Address - Street 1:6601 N AVONDALE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1572
Practice Address - Country:US
Practice Address - Phone:773-774-4444
Practice Address - Fax:773-774-4447
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009952101YP2500X
IL180.010547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional