Provider Demographics
NPI:1386235687
Name:RIVERA, ALLYSSA S (BC-DMT, LCAT)
Entity type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:S
Last Name:RIVERA
Suffix:
Gender:F
Credentials:BC-DMT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1702
Mailing Address - Country:US
Mailing Address - Phone:347-659-0973
Mailing Address - Fax:
Practice Address - Street 1:16 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-2340
Practice Address - Country:US
Practice Address - Phone:347-659-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002211225600000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist