MEDICARE: JENNIFER RIVERA I MFT ,PCC

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	101YP2500X	Professional Counselor	APCC19096
2	106H00000X	Marriage & Family Therapist	AMFT153764	CA

General Provider Information

NPI Number	:	1457144511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RIVERA I MFT ,PCC

Provider Business Mailing Address
First Line	:	1143 GLENVILLE DR APT 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1219
Country	:	US
Telephone Number	:	619-886-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1143 GLENVILLE DR APT 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1219
Country	:	US
Telephone Number	:	619-886-8691
Fax Number	:

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

Provider Enumeration Date	:	05/22/2025
Last Update Date	:	05/22/2025

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Directions to “ JENNIFER RIVERA I MFT ,PCC” Practice Location

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