Healthcare Provider Details

I. General information

NPI: 1699685727
Provider Name (Legal Business Name): RICHARD BETANCOURT RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

79 N CLINTON AVE
ROCHESTER NY
14604-1407
US

IV. Provider business mailing address

434 DRIVING PARK AVE
ROCHESTER NY
14613-1932
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-7220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP145473
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: