Provider Demographics
NPI:1356874085
Name:RIVERA, NICOLE VANESSA (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:VANESSA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FORBES AVE
Mailing Address - Street 2:FORBES TOWER PLAZA SUITE 140
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:345 BLACKSTONE BLV
Practice Address - Street 2:PSYCHIATRY
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-0290
Practice Address - Country:US
Practice Address - Phone:401-455-6200
Practice Address - Fax:401-455-6689
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD175212084P0800X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry