Provider Demographics
NPI:1558425835
Name:RIVERA, VICTORIA (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 CAMINO DIABLO
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3988
Mailing Address - Country:US
Mailing Address - Phone:925-934-7590
Mailing Address - Fax:
Practice Address - Street 1:2960 CAMINO DIABLO
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3988
Practice Address - Country:US
Practice Address - Phone:925-934-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist