MEDICARE: MONIQUE RIVERA

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	104100000X	Social Worker	M-10645	NM
2	1041C0700X	Clinical Social Worker	SWB-2022-0492	NM

General Provider Information

NPI Number	:	1104390244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE RIVERA

Provider Business Mailing Address
First Line	:	306 WASHINGTON ST SE ALBUQUERQUE, NM 87108
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-2360
Country	:	US
Telephone Number	:	505-577-8473
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 WASHINGTON ST SE ALBUQUERQUE, NM 87108
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-2360
Country	:	US
Telephone Number	:	505-577-8473
Fax Number	:

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

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	08/18/2022

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Directions to “ MONIQUE RIVERA ” Practice Location

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