Healthcare Provider Details

I. General information

NPI: 1184064412
Provider Name (Legal Business Name): BRANDY RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 2ND AVE STE 208
SEATTLE WA
98101-1186
US

IV. Provider business mailing address

6739 FLORA AVE S
SEATTLE WA
98108-3540
US

V. Phone/Fax

Practice location:
  • Phone: 206-956-9570
  • Fax: 206-448-8495
Mailing address:
  • Phone: 253-223-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60191640
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: