Provider Demographics
NPI:1831262484
Name:RIVERA, JO ANN M (PHD)
Entity type:Individual
Prefix:DR
First Name:JO ANN
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 PELHAM PARKWAY SOUTH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1027
Mailing Address - Country:US
Mailing Address - Phone:718-829-0652
Mailing Address - Fax:718-228-0136
Practice Address - Street 1:1122 PELHAM PARKWAY SOUTH
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1027
Practice Address - Country:US
Practice Address - Phone:718-829-0652
Practice Address - Fax:718-228-0136
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021342OtherGHC NYS EMPIRE
00601487001OtherUNITED HEALTHCARE
221852OtherMANAGED HEALTH NETWORK
32332OtherUBH
221852OtherMANAGED HEALTH NETWORK