MEDICARE: JEFFREY M RIVERA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1871328096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M RIVERA

Provider Business Mailing Address
First Line	:	12428 GRANGER RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-2943
Country	:	US
Telephone Number	:	216-299-5674
Fax Number	:

Provider Business Practice Location Address
First Line	:	12428 GRANGER RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-2943
Country	:	US
Telephone Number	:	216-299-5674
Fax Number	:

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

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/06/2024

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Directions to “ JEFFREY M RIVERA ” Practice Location

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