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General NPI Number Information
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NPI Number | 1073100897
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Entity Type | Individual
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Provider Name | KERRY RIVERA LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 631 MONTAUK HWY STE 9
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City | WEST ISLIP
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State | NY
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Zip | 11795-4400
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Country | US
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Telephone | 631-319-9512
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Fax |
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Provider Business Mailing Address
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Address Line | 17 BARBERRY RD
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City | WEST ISLIP
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State | NY
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Zip | 11795-3910
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Country | US
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Telephone | 631-793-3435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 056611-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 098466-01
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License Number State | NY
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