Healthcare Provider Details

I. General information

NPI: 1083523492
Provider Name (Legal Business Name): JEAN M RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWLES PARK
SPRINGFIELD MA
01104-1533
US

IV. Provider business mailing address

100 BOWLES PARK
SPRINGFIELD MA
01104-1533
US

V. Phone/Fax

Practice location:
  • Phone: 787-678-9304
  • Fax:
Mailing address:
  • Phone: 787-678-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: