MEDICARE: HOLLY A RIVERA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2020010967	MO

General Provider Information

NPI Number	:	1285373878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY A RIVERA LCSW

Provider Business Mailing Address
First Line	:	222 S MERAMEC AVE STE 202-1026
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1805
Country	:	US
Telephone Number	:	314-514-5395
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S MERAMEC AVE STE 202-1026
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1805
Country	:	US
Telephone Number	:	314-514-5395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	12/27/2022

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Directions to “ HOLLY A RIVERA LCSW” Practice Location

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