Provider Demographics
NPI:1104432582
Name:RIVERA, CHARLES (BSW, CSAC, CCJP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:BSW, CSAC, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 PATTERSON RD # MHS-116
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1522
Mailing Address - Country:US
Mailing Address - Phone:808-433-3010
Mailing Address - Fax:808-433-0395
Practice Address - Street 1:459 PATTERSON RD # MHS-116
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-3010
Practice Address - Fax:808-433-0395
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health