Provider Demographics
NPI:1396146536
Name:RIVERA, TELVA (LMSW)
Entity type:Individual
Prefix:
First Name:TELVA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E 120TH ST APT 9A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3676
Mailing Address - Country:US
Mailing Address - Phone:347-957-9840
Mailing Address - Fax:
Practice Address - Street 1:3410 108TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1222
Practice Address - Country:US
Practice Address - Phone:347-287-0175
Practice Address - Fax:347-287-0172
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program