Provider Demographics
NPI:1619329620
Name:RIVERA, LINDSY
Entity type:Individual
Prefix:
First Name:LINDSY
Middle Name:
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 1:4806 STOCKBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-6347
Mailing Address - Country:US
Mailing Address - Phone:440-465-1524
Mailing Address - Fax:440-643-2180
Practice Address - Street 1:7650 CHIPPEWA RD STE 205
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2300
Practice Address - Country:US
Practice Address - Phone:440-589-7855
Practice Address - Fax:440-643-2180
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901279101Y00000X
OHS1200837104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1619329620Medicaid