Provider Demographics
NPI:1124303052
Name:RIVERA, ANDRES JR
Entity type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CORLEAR ST
Mailing Address - Street 2:2
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-2107
Mailing Address - Country:US
Mailing Address - Phone:518-445-5487
Mailing Address - Fax:
Practice Address - Street 1:845 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1514
Practice Address - Country:US
Practice Address - Phone:518-482-2455
Practice Address - Fax:518-482-2458
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)