Healthcare Provider Details

I. General information

NPI: 1811548647
Provider Name (Legal Business Name): MARILYN ELIZABETH RIVERA MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E CRANDALL AVE
HARRISON AR
72601-3628
US

IV. Provider business mailing address

1219 MAPLEWOOD RD
HARRISON AR
72601-3008
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8484
  • Fax:
Mailing address:
  • Phone: 501-766-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM2576
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2576-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: