Healthcare Provider Details

I. General information

NPI: 1235158981
Provider Name (Legal Business Name): HENRY EUGENE RIVERA II PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAPLE ST
SPRINGFIELD MA
01103-1930
US

IV. Provider business mailing address

PO BOX 268
LEEDS MA
01053-0268
US

V. Phone/Fax

Practice location:
  • Phone: 413-707-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8601
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: