Provider Demographics
NPI:1740930429
Name:RIVA, BROOKE SARAH (BACHELORS)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:SARAH
Last Name:RIVA
Suffix:
Gender:F
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26955 CALAMINE DR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2334
Mailing Address - Country:US
Mailing Address - Phone:818-644-1644
Mailing Address - Fax:
Practice Address - Street 1:26955 CALAMINE DR
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91301-2334
Practice Address - Country:US
Practice Address - Phone:818-644-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician