Healthcare Provider Details

I. General information

NPI: 1134017767
Provider Name (Legal Business Name): REBECCA RIVAS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BROAD ST STE 606
NEWARK NJ
07102-4537
US

IV. Provider business mailing address

4201 HENRY AVE
PHILADELPHIA PA
19144-5409
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-1161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033183
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15374000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: