Healthcare Provider Details

I. General information

NPI: 1164327367
Provider Name (Legal Business Name): MIYA RIVERA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

243 S BUTLER RD
LEBANON PA
17042-8939
US

IV. Provider business mailing address

389 N BARBARA ST APT 2
MOUNT JOY PA
17552-1423
US

V. Phone/Fax

Practice location:
  • Phone: 717-279-2791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: