MEDICARE: NATHALIA RUIZ 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	104100000X	Social Worker	C016723	NC

General Provider Information

NPI Number	:	1548867781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIA RUIZ RIVERA LCSW

Provider Business Mailing Address
First Line	:	1021 MOREHEAD MEDICAL DR BLDG 2
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2990
Country	:	US
Telephone Number	:	704-807-1194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 MOREHEAD MEDICAL DR BLDG 2
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2990
Country	:	US
Telephone Number	:	704-807-1194
Fax Number	:

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

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	12/22/2025

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