Healthcare Provider Details

I. General information

NPI: 1891689337
Provider Name (Legal Business Name): GABRIELLE INETTE RIVERA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CLIFTON ST
NEW HAVEN CT
06513-3313
US

IV. Provider business mailing address

34 CLIFTON ST
NEW HAVEN CT
06513-3313
US

V. Phone/Fax

Practice location:
  • Phone: 475-988-5518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8621
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: