Healthcare Provider Details

I. General information

NPI: 1548977879
Provider Name (Legal Business Name): LUIS RIVERA LMHC, LMFT, CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N VILLAGE AVE STE 2B
ROCKVILLE CENTRE NY
11570-4610
US

IV. Provider business mailing address

45 N VILLAGE AVE STE 2B
ROCKVILLE CENTRE NY
11570-4610
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-2797
  • Fax: 516-536-7771
Mailing address:
  • Phone: 516-536-2797
  • Fax: 516-536-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000511
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12504
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000660
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: