Provider Demographics
NPI:1366920886
Name:RIVERA MATOS, RUT LYMARI
Entity type:Individual
Prefix:
First Name:RUT
Middle Name:LYMARI
Last Name:RIVERA MATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 WORCESTER RD APT 210C
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5439
Mailing Address - Country:US
Mailing Address - Phone:787-309-9014
Mailing Address - Fax:
Practice Address - Street 1:95 FRANK B MURRAY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1106
Practice Address - Country:US
Practice Address - Phone:787-309-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker