Provider Demographics
NPI:1750741088
Name:RIVERA, WEENA (MA)
Entity type:Individual
Prefix:
First Name:WEENA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 MOUNTAIN CREEK RD
Mailing Address - Street 2:APT E59
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1700
Mailing Address - Country:US
Mailing Address - Phone:423-280-3559
Mailing Address - Fax:
Practice Address - Street 1:936 MOUNTAIN CREEK RD E-59
Practice Address - Street 2:APT E59
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405
Practice Address - Country:US
Practice Address - Phone:423-280-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017979Medicaid