Healthcare Provider Details

I. General information

NPI: 1457041535
Provider Name (Legal Business Name): JEAN ALEA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 ROCK LN
MILFORD CT
06460-3831
US

IV. Provider business mailing address

291 ROCK LN
MILFORD CT
06460-3831
US

V. Phone/Fax

Practice location:
  • Phone: 203-306-7338
  • Fax:
Mailing address:
  • Phone: 203-306-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: