Provider Demographics
NPI:1215621867
Name:RIVERA, RITA MICHELLE (PSYD, CBIS, CTP)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:MICHELLE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PSYD, CBIS, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 MCQUEEN DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-8806
Mailing Address - Country:US
Mailing Address - Phone:919-987-7955
Mailing Address - Fax:
Practice Address - Street 1:55 LOCK ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3603
Practice Address - Country:US
Practice Address - Phone:203-432-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist