Provider Demographics
NPI:1104622877
Name:RIVERA, CAROLYNN JANE
Entity type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:JANE
Last Name:RIVERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LADERA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8301
Mailing Address - Country:US
Mailing Address - Phone:860-334-6501
Mailing Address - Fax:
Practice Address - Street 1:8 LADERA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8301
Practice Address - Country:US
Practice Address - Phone:860-334-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health