Healthcare Provider Details

I. General information

NPI: 1548121890
Provider Name (Legal Business Name): ALYSSA RIVERA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 CREST HAVEN RD
CAPE MAY COURT HOUSE NJ
08210-1651
US

IV. Provider business mailing address

42 DELSEA DR S
GLASSBORO NJ
08028-2621
US

V. Phone/Fax

Practice location:
  • Phone: 844-422-3632
  • Fax:
Mailing address:
  • Phone: 844-422-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07278000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: