Provider Demographics
NPI:1851890362
Name:CHEVERE-RIVERA, CRISTINA N
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:N
Last Name:CHEVERE-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 1:170 S 1000 E STE 201
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1403
Mailing Address - Country:US
Mailing Address - Phone:801-419-0139
Mailing Address - Fax:855-710-7443
Practice Address - Street 1:170 S 1000 E STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1403
Practice Address - Country:US
Practice Address - Phone:801-419-0139
Practice Address - Fax:855-710-7443
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT12420227-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program