Provider Demographics
NPI:1972075802
Name:RIVERA, CARLOS ALBERTO (LCSW)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SHERMAN AVE FL 1RST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5204
Mailing Address - Country:US
Mailing Address - Phone:203-781-0226
Mailing Address - Fax:203-781-0229
Practice Address - Street 1:116 SHERMAN AVE FL 1RST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5204
Practice Address - Country:US
Practice Address - Phone:203-781-0226
Practice Address - Fax:203-781-0229
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0039421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical