Provider Demographics
NPI:1285373878
Name:RIVERA, HOLLY A (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
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 1:222 S MERAMEC AVE STE 202-1026
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1805
Mailing Address - Country:US
Mailing Address - Phone:314-514-5395
Mailing Address - Fax:
Practice Address - Street 1:222 S MERAMEC AVE STE 202-1026
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1805
Practice Address - Country:US
Practice Address - Phone:314-514-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200109671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty