Provider Demographics
NPI:1316712763
Name:RIVERA, MONICAH (PMHNP)
Entity type:Individual
Prefix:
First Name:MONICAH
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 STEDMAN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2850
Mailing Address - Country:US
Mailing Address - Phone:978-799-3193
Mailing Address - Fax:
Practice Address - Street 1:59 LOWES WAY
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-5018
Practice Address - Country:US
Practice Address - Phone:978-565-0569
Practice Address - Fax:978-226-4454
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2321959163WC1500X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health