Healthcare Provider Details

I. General information

NPI: 1831020114
Provider Name (Legal Business Name): PHOEBE RIVERA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 OLD MILL RD
SOUTHFIELDS NY
10975-2621
US

IV. Provider business mailing address

205 OLD MILL RD
SOUTHFIELDS NY
10975-2621
US

V. Phone/Fax

Practice location:
  • Phone: 845-537-5652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130857
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: