Healthcare Provider Details

I. General information

NPI: 1912773557
Provider Name (Legal Business Name): RIVERA WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 ROSEMONT AVE
FREDERICK MD
21702-4134
US

IV. Provider business mailing address

6478 CORNWALL DR UNIT 25
ELDERSBURG MD
21784-6694
US

V. Phone/Fax

Practice location:
  • Phone: 240-366-7724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JASMINE ARIEL RIVERA
Title or Position: OWNER, THERAPIST
Credential: LCPC
Phone: 240-366-7724