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NPI Code Detail

MEDICARE: MISS ABIGAIL RIVERA BSW

MEDICARE: MISS ABIGAIL RIVERA BSW
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1R160-0009-8925OTHERILLICENSE

General Provider Information

NPI Number : 1538730395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ABIGAIL RIVERA BSW
Provider Business Mailing Address
First Line : 5097 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2463
Country : US
Telephone Number : 312-296-8627
Fax Number :
Provider Business Practice Location Address
First Line : 5097 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2463
Country : US
Telephone Number : 312-296-8627
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2021
Last Update Date : 07/02/2021

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Directions to “ MISS ABIGAIL RIVERA BSW” Practice Location

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