MEDICARE: DANETTE 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
2	1041C0700X	Clinical Social Worker	SCS61001445	WA

General Provider Information

NPI Number	:	1407255144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANETTE RIVERA

Provider Business Mailing Address
First Line	:	3025 E SPANGLE WAVERLY RD
Second Line	:
City	:	SPANGLE
State	:	WA
Zip	:	99031-9703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 E SPANGLE WAVERLY RD
Second Line	:
City	:	SPANGLE
State	:	WA
Zip	:	99031-9703
Country	:	US
Telephone Number	:	423-596-2917
Fax Number	:

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/23/2023

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Directions to “ DANETTE RIVERA ” Practice Location

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