Healthcare Provider Details

I. General information

NPI: 1801949789
Provider Name (Legal Business Name): SANDY V RIVERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 LAKE STREET
NEWBURGH NY
12550-5242
US

IV. Provider business mailing address

PO BOX 528
CORNWALL NY
12518-0528
US

V. Phone/Fax

Practice location:
  • Phone: 845-563-8000
  • Fax:
Mailing address:
  • Phone: 845-220-3100
  • Fax: 845-534-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05282800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076430-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: