Provider Demographics
NPI:1992967533
Name:RIVERA, DEA RAE (MFT)
Entity type:Individual
Prefix:MS
First Name:DEA
Middle Name:RAE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DEA
Other - Middle Name:RAE
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1601 CARMEN DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3105
Mailing Address - Country:US
Mailing Address - Phone:805-987-7006
Mailing Address - Fax:
Practice Address - Street 1:1601 CARMEN DR
Practice Address - Street 2:SUITE 111
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3105
Practice Address - Country:US
Practice Address - Phone:805-987-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
CAMFC39066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool