Provider Demographics
NPI:1881164671
Name:RIVERA, LISETTE (LPC)
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLLINGSWOOD HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1957
Mailing Address - Country:US
Mailing Address - Phone:267-273-4673
Mailing Address - Fax:
Practice Address - Street 1:1100 E ERIE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5424
Practice Address - Country:US
Practice Address - Phone:215-533-6700
Practice Address - Fax:267-345-0531
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional