Healthcare Provider Details

I. General information

NPI: 1720906217
Provider Name (Legal Business Name): EILEEN MAYTE RIVERA SALAS LP MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 YATES AVE APT 2F
BRONX NY
10461-2026
US

IV. Provider business mailing address

1571 YATES AVE APT 2F
BRONX NY
10461-2026
US

V. Phone/Fax

Practice location:
  • Phone: 347-464-9048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: