1174810147 NPI number — MS. AKEISHA LA TOYA RIVERA PSY.D.

Table of content: MS. AKEISHA LA TOYA RIVERA PSY.D. (NPI 1174810147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174810147 NPI number — MS. AKEISHA LA TOYA RIVERA PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
AKEISHA
Provider Middle Name:
LA TOYA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MITCHELL
Provider Other First Name:
AKEISHA
Provider Other Middle Name:
LA TOYA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174810147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 RAMONA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550-7010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-425-1321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WESTCHESTER AVE STE N641
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RYE BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-231-0362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2011

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: 103TC0700X , with the licence number:  020809 , 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)





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