Provider Demographics
NPI:1154699734
Name:RIVERO, RACQUEL (LPC, RPT)
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:
Last Name:RIVERO
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RHEA RD
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1019
Mailing Address - Country:US
Mailing Address - Phone:732-865-5288
Mailing Address - Fax:
Practice Address - Street 1:170 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3530
Practice Address - Country:US
Practice Address - Phone:732-865-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor