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General NPI Number Information
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NPI Number | 1780042374
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Entity Type | Individual
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Provider Name | BRIDGETT RIVERA LPCC-S, LICDC
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Gender | Female
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 202 EAST SAFFLE AVENUE
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City | SYCAMORE
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State | OH
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Zip | 44882-0362
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Country | US
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Telephone | 419-934-2214
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 362
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City | SYCAMORE
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State | OH
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Zip | 44882-0362
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Country | US
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Telephone | 419-721-1810
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C1400098
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 111130
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2001602-SUPV
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License Number State | OH
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