MEDICARE: SHANA RIVERA COUNSELING, LLC

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CW020559	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1659071041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANA RIVERA COUNSELING, LLC

Provider Business Mailing Address
First Line	:	4417 SAYBROOK LN
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-3479
Country	:	US
Telephone Number	:	717-856-8482
Fax Number	:

Provider Business Practice Location Address
First Line	:	4417 SAYBROOK LN
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-3479
Country	:	US
Telephone Number	:	717-856-8482
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANA RIVERA
Credential	:	LCSW
Telephone Number	:	717-856-8472

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	03/06/2023

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