Provider Demographics
NPI:1477085470
Name:RIVERA, CARLOS (LSCSW)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3343
Mailing Address - Country:US
Mailing Address - Phone:620-253-4960
Mailing Address - Fax:
Practice Address - Street 1:1025 RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3343
Practice Address - Country:US
Practice Address - Phone:620-253-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS058551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical