Provider Demographics
NPI:1841896271
Name:RIVERA, NOAH THOMAS
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:THOMAS
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 MAPLE SHADE LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3424
Mailing Address - Country:US
Mailing Address - Phone:302-357-0844
Mailing Address - Fax:
Practice Address - Street 1:1167 W BALTIMORE PIKE # 258
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5127
Practice Address - Country:US
Practice Address - Phone:484-577-9928
Practice Address - Fax:484-585-1697
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician