1639506124 NPI number — DR. DAISY MARIELA RIVERA PSYD, LMHC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639506124 NPI number — DR. DAISY MARIELA RIVERA PSYD, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
DAISY
Provider Middle Name:
MARIELA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAUKAU
Provider Other First Name:
DAISY
Provider Other Middle Name:
MARIELA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639506124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 SKYLINE DR APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRACUT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01826-6122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-387-3182
Provider Business Mailing Address Fax Number:
509-664-4590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01901-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-477-7222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2013

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: 101YM0800X , with the licence number:  LH60748230 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2085250 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".