Provider Demographics
NPI:1285906248
Name:RIVERA, FELICIA JACQUELINE (LISW)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:JACQUELINE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2794
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-2794
Mailing Address - Country:US
Mailing Address - Phone:505-426-6462
Mailing Address - Fax:505-212-0377
Practice Address - Street 1:1103 NATIONAL AVENUE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-8770
Practice Address - Country:US
Practice Address - Phone:505-426-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07414104100000X
NMI-08306104100000X
NMC-083061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker