MEDICARE: EMMY RIVERA LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	R039281-1	NY

General Provider Information

NPI Number	:	1548479454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMY RIVERA LCSW

Provider Business Mailing Address
First Line	:	2200 POWELL AVE
Second Line	:	F-21
City	:	BRONX
State	:	NY
Zip	:	10462-5100
Country	:	US
Telephone Number	:	917-806-7912
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 W 124TH ST
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10027-4920
Country	:	US
Telephone Number	:	917-386-1799
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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