Provider Demographics
NPI:1588556880
Name:RIVERA, MAX
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:ALYSA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4830 N PULASKI RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2846
Mailing Address - Country:US
Mailing Address - Phone:312-802-2917
Mailing Address - Fax:
Practice Address - Street 1:4830 N PULASKI RD STE 110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2846
Practice Address - Country:US
Practice Address - Phone:312-802-2917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician