Healthcare Provider Details

I. General information

NPI: 1639400930
Provider Name (Legal Business Name): EDGAR JOSUE RIVERA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 SUNSET LN STE 110
ANTIOCH CA
94509-6134
US

IV. Provider business mailing address

3727 SUNSET LN STE 110
ANTIOCH CA
94509-6134
US

V. Phone/Fax

Practice location:
  • Phone: 925-778-1667
  • Fax:
Mailing address:
  • Phone: 925-778-1667
  • Fax: 925-778-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: