Provider Demographics
NPI:1700945912
Name:RIVERA ARZOLA, MIGDALIA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MIGDALIA
Middle Name:
Last Name:RIVERA ARZOLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SILAS DEANE HWY STE 402
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2119
Mailing Address - Country:US
Mailing Address - Phone:860-721-0606
Mailing Address - Fax:860-721-0202
Practice Address - Street 1:415 SILAS DEANE HWY STE 402
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2119
Practice Address - Country:US
Practice Address - Phone:860-721-0606
Practice Address - Fax:860-721-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CT001975103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004140159Medicaid
CT004140159Medicaid