Healthcare Provider Details

I. General information

NPI: 1386268282
Provider Name (Legal Business Name): JIMARIE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 PLEASANT ST
WILLIMANTIC CT
06226-3219
US

IV. Provider business mailing address

355 HIGH ST UNIT C
WILLIMANTIC CT
06226-1306
US

V. Phone/Fax

Practice location:
  • Phone: 860-771-0679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: