Provider Demographics
NPI:1780955484
Name:RIVERA, OMAR (LCSW)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CONNECTICUT BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3013
Mailing Address - Country:US
Mailing Address - Phone:860-297-0800
Mailing Address - Fax:860-297-0931
Practice Address - Street 1:270 JOHN DOWNEY DR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2906
Practice Address - Country:US
Practice Address - Phone:860-826-1358
Practice Address - Fax:860-229-8886
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0078771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical