Provider Demographics
NPI:1588728463
Name:RIVERA, CARMEN B (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:B
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 TELEGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2641
Mailing Address - Country:US
Mailing Address - Phone:516-488-8169
Mailing Address - Fax:516-488-4720
Practice Address - Street 1:110 JERICHO TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2019
Practice Address - Country:US
Practice Address - Phone:516-488-8169
Practice Address - Fax:516-488-4720
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0288951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY176997OtherMHN
NY47276336OtherMULTIPLAN
NY6268860OtherUNITED BEHAV. HEALTH
NYN5980OtherEMPIRE
NY7401098OtherGHI
NYP1611418OtherOXFORD
NYN113587Other1199 NATL HEALTH FUND
NY5796035OtherAETNA
NY090490OtherVALUE OPTIONS
NYRC8895OtherATLANTIS HEALTH PLAN