Healthcare Provider Details

I. General information

NPI: 1992967533
Provider Name (Legal Business Name): DEA RAE RIVERA M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEA RAE PIERCE M.F.T.

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CARMEN DR SUITE 111
CAMARILLO CA
93010-3105
US

IV. Provider business mailing address

1601 CARMEN DR SUITE 111
CAMARILLO CA
93010-3105
US

V. Phone/Fax

Practice location:
  • Phone: 805-987-7006
  • Fax:
Mailing address:
  • Phone: 805-987-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: