Provider Demographics
NPI:1114723400
Name:RIVERA MARRERO, GLADIMAR (LSW)
Entity type:Individual
Prefix:
First Name:GLADIMAR
Middle Name:
Last Name:RIVERA MARRERO
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COUNTRY PLACE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:18661-3028
Mailing Address - Country:US
Mailing Address - Phone:787-205-2690
Mailing Address - Fax:
Practice Address - Street 1:108 COUNTRY PLACE LN
Practice Address - Street 2:
Practice Address - City:WHITE HAVEN
Practice Address - State:PA
Practice Address - Zip Code:18661-3028
Practice Address - Country:US
Practice Address - Phone:787-205-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142359104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker