=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063324580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVIVIR PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2026
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1220 BUTLER ST
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18042-4712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-748-0484
-----------------------------------------------------
Fax | 551-202-7648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 212 S 1ST ST
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18013-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-748-0484
-----------------------------------------------------
Fax | 551-202-7648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEBORA MONSERRAT
-----------------------------------------------------
Credential | CRNP-BC
-----------------------------------------------------
Telephone | 484-748-0484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------