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General NPI Number Information
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NPI Number | 1750635611
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Entity Type | Organization
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Legal Business Name | ANA RIVERA CORPORATION
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 241 CLEVELAND AVE S
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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 |
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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 | 612-396-3963
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | ANA MARIELLA RIVERA
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Credential | LICSW
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Telephone | 612-396-3963
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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 | 17718
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License Number State | MN
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