Provider Demographics
NPI:1881961811
Name:RIVAS, ANGELICA MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:RIVAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 S H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-5948
Mailing Address - Country:US
Mailing Address - Phone:661-328-4260
Mailing Address - Fax:661-617-2888
Practice Address - Street 1:9001 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-5948
Practice Address - Country:US
Practice Address - Phone:661-328-4260
Practice Address - Fax:661-617-2888
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA822441041C0700X
CAASW678371041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program