Healthcare Provider Details

I. General information

NPI: 1811986409
Provider Name (Legal Business Name): JESSE ALVIN RIEBER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SPRING ST SUITE 206
NEW BEDFORD MA
02740-5951
US

IV. Provider business mailing address

106 SPRING ST SUITE 206
NEW BEDFORD MA
02740-5951
US

V. Phone/Fax

Practice location:
  • Phone: 508-999-3290
  • Fax: 508-999-3290
Mailing address:
  • Phone: 508-999-3290
  • Fax: 508-999-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC3758
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: