Provider Demographics
NPI:1952894867
Name:RIVERA, RICKI (CDCA)
Entity Type:Individual
Prefix:
First Name:RICKI
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 N CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1110
Mailing Address - Country:US
Mailing Address - Phone:307-938-9513
Mailing Address - Fax:330-754-0125
Practice Address - Street 1:1051 N CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1110
Practice Address - Country:US
Practice Address - Phone:307-939-8513
Practice Address - Fax:330-754-0125
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.166223101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)