MEDICARE: MR. DAVID MATTHEW RIVERS CRPA-6816

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	175T00000X	Peer Specialist	CERPA-6816	NY

General Provider Information

NPI Number	:	1346103033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID MATTHEW RIVERS CRPA-6816

Provider Business Mailing Address
First Line	:	4778 BROADWAY # 7B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-4916
Country	:	US
Telephone Number	:	646-359-6512
Fax Number	:

Provider Business Practice Location Address
First Line	:	4778 BROADWAY # 7B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-4916
Country	:	US
Telephone Number	:	646-359-6512
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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