MEDICARE: LORNA 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	101YP2500X	Professional Counselor	036107036	IL
2	2084N0400X	Neurology Physician	036107036	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730197906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORNA RIVERA

Provider Business Mailing Address
First Line	:	4100 VETERANS PKWY
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 VETERANS PKWY
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4029
Country	:	US
Telephone Number	:	815-385-6400
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/17/2022

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Directions to “ LORNA RIVERA ” Practice Location

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