Provider Demographics
NPI:1780997650
Name:RIVERS, HENRY LEE SR (BA)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LEE
Last Name:RIVERS
Suffix:SR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:260 E 161ST ST
Mailing Address - Street 2:T-LEVEL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3512
Mailing Address - Country:US
Mailing Address - Phone:718-993-3397
Mailing Address - Fax:718-292-1980
Practice Address - Street 1:260 EAST 161 STREET
Practice Address - Street 2:T-LEVEL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-993-3397
Practice Address - Fax:718-292-1980
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)