Provider Demographics
NPI:1427395797
Name:RIVERS, DENISE LOUISE
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LOUISE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:LOUISE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, CADC
Mailing Address - Street 1:1012 N DRAKE AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-4012
Mailing Address - Country:US
Mailing Address - Phone:773-276-4364
Mailing Address - Fax:
Practice Address - Street 1:1127 N OAKLEY BLVD
Practice Address - Street 2:3RD FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3507
Practice Address - Country:US
Practice Address - Phone:312-770-3406
Practice Address - Fax:312-770-2557
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL262171079Medicaid