Provider Demographics
NPI:1992471692
Name:RIVERA, MARIAH (LGSW, LMSW)
Entity type:Individual
Prefix:MS
First Name:MARIAH
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LGSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5901
Mailing Address - Country:US
Mailing Address - Phone:202-630-2129
Mailing Address - Fax:
Practice Address - Street 1:3817 7TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5901
Practice Address - Country:US
Practice Address - Phone:202-630-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083196104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty