Provider Demographics
NPI:1154608834
Name:RIVERA, JAMY GIZEL (LCSW)
Entity type:Individual
Prefix:MS
First Name:JAMY
Middle Name:GIZEL
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W LOOCKERMAN ST APT 203
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7313
Mailing Address - Country:US
Mailing Address - Phone:302-730-0720
Mailing Address - Fax:302-730-0725
Practice Address - Street 1:32 W LOOCKERMAN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7352
Practice Address - Country:US
Practice Address - Phone:302-730-0720
Practice Address - Fax:302-730-0725
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084717104100000X
DEQ1-00014961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical