Provider Demographics
NPI:1396557732
Name:RIVERA, LAKESH LASHRON
Entity type:Individual
Prefix:
First Name:LAKESH
Middle Name:LASHRON
Last Name:RIVERA
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:CMR 415 BOX 8177
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114-1082
Mailing Address - Country:US
Mailing Address - Phone:386-346-0681
Mailing Address - Fax:
Practice Address - Street 1:CMR 415 BOX 8177
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09114-1082
Practice Address - Country:US
Practice Address - Phone:386-346-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical