Provider Demographics
NPI:1811765704
Name:RIVERA, VANESSA MICHELLE (AMFT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MICHELLE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 KENDALL CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2452
Mailing Address - Country:US
Mailing Address - Phone:909-224-8299
Mailing Address - Fax:
Practice Address - Street 1:3835 AVOCADO BLVD STE 270
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-8524
Practice Address - Country:US
Practice Address - Phone:888-688-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist