MEDICARE: MARIA KASSANDRA RIVAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	108412	TX

General Provider Information

NPI Number	:	1043189491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA KASSANDRA RIVAS LCSW

Provider Business Mailing Address
First Line	:	8251 RETTA MANSFIELD RD
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-4239
Country	:	US
Telephone Number	:	682-560-5642
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 OWEN CT STE 100
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-4235
Country	:	US
Telephone Number	:	817-812-2880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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