Healthcare Provider Details

I. General information

NPI: 1881008993
Provider Name (Legal Business Name): KELLY MARIE RIVERA MSW, LMSW, LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE BLDG 194TH
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 WISCONSIN AVE BLDG 194TH
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-8018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW 56104
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008806
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: