Provider Demographics
NPI:1992958607
Name:RIVERA, LAURA D (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:D
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BROADMERE RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-2505
Mailing Address - Country:US
Mailing Address - Phone:203-647-0212
Mailing Address - Fax:203-647-0243
Practice Address - Street 1:82 BROADMERE RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-2505
Practice Address - Country:US
Practice Address - Phone:203-647-0212
Practice Address - Fax:203-647-0243
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist