Provider Demographics
NPI:1962752832
Name:RIVERA, IRAIDA VIRGINIA (LPC)
Entity type:Individual
Prefix:MS
First Name:IRAIDA
Middle Name:VIRGINIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 SAINT HELEN CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2459
Mailing Address - Country:US
Mailing Address - Phone:571-278-1935
Mailing Address - Fax:
Practice Address - Street 1:2940 SAINT HELEN CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2459
Practice Address - Country:US
Practice Address - Phone:571-278-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional