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General NPI Number Information
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NPI Number | 1801629167
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Entity Type | Individual
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Provider Name | JONATHAN O RIVERA LMSW
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Gender | Male
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 369 LEXINGTON AVE RM 14A
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City | NEW YORK
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State | NY
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Zip | 10017-6526
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Country | US
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Telephone | 212-204-8430
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Fax |
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Provider Business Mailing Address
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Address Line | 3431 81ST ST APT B64
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-2850
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Country | US
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Telephone | 347-944-4900
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 128032
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License Number State | NY
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