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General NPI Number Information
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NPI Number | 1164649463
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Entity Type | Individual
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Provider Name | ANA MARIELLA RIVERA LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 241 CLEVELAND AVE S SUITE A7
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City | SAINT PAUL
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State | MN
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Zip | 55105-1208
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Country | US
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Telephone | 612-396-3963
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Fax | 612-871-1058
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Provider Business Mailing Address
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Address Line | 3533 16TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-2305
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Country | US
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Telephone | 312-396-3963
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 17718
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License Number State |
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