Healthcare Provider Details

I. General information

NPI: 1922729276
Provider Name (Legal Business Name): GABRIELLE A RIVERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MOON ST NE
ALBUQUERQUE NM
87112-3935
US

IV. Provider business mailing address

6635 W HAPPY VALLEY RD STE A104-621
GLENDALE AZ
85310-2609
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-0329
  • Fax: 505-271-4957
Mailing address:
  • Phone: 602-358-7073
  • Fax: 888-927-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0005
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-19655
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: