1588728463 NPI number — MS. CARMEN B RIVERA LCSW

Table of content: MS. CARMEN B RIVERA LCSW (NPI 1588728463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588728463 NPI number — MS. CARMEN B RIVERA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
CARMEN
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588728463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1323 TELEGRAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11003-2641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-488-8169
Provider Business Mailing Address Fax Number:
516-488-4720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 JERICHO TPKE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FLORAL PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11001-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-488-8169
Provider Business Practice Location Address Fax Number:
516-488-4720
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R028895 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 176997 . This is a "MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 47276336 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6268860 . This is a "UNITED BEHAV. HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N5980 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7401098 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1611418 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N113587 . This is a "1199 NATL HEALTH FUND" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5796035 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 090490 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RC8895 . This is a "ATLANTIS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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