Provider Demographics
NPI:1972543338
Name:RIVERA, LUIS A (PHD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:A
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-6340
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008271L103T00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA620006804OtherRAILROAD MEDICARE
PA176911000OtherMAGELLAN
PA01096302OtherCAPITAL BLUE CROSS
PA124991OtherVALUE OPTIONS
PA2057198OtherCIGNA BEHAVIORAL HEALTH
PA875698OtherPA BLUE SHIELD
PA68711601OtherBC/BS MARYLAND CAREFIRST
PA243651OtherMAMSI
PA620006804OtherRAILROAD MEDICARE
PAS32436Medicare UPIN