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General NPI Number Information
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NPI Number | 1891064796
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Entity Type | Individual
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Provider Name | AIDA RIVERA LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 445 OAK ST 2ND FLOOR
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City | COPIAGUE
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State | NY
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Zip | 11726-3111
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Country | US
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Telephone | 631-257-5173
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Fax |
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Provider Business Mailing Address
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Address Line | 37 3RD AVE
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-3007
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Country | US
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Telephone | 631-524-1323
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 084853
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License Number State | NY
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