MEDICARE: DR. JO ANN M RIVERA PHD

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	103TC0700X	Clinical Psychologist	006738	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0021342	OTHER	GHC NYS EMPIRE
2	00601487001	OTHER	UNITED HEALTHCARE
3	221852	OTHER	MANAGED HEALTH NETWORK
4	32332	OTHER	UBH

General Provider Information

NPI Number	:	1831262484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JO ANN M RIVERA PHD

Provider Business Mailing Address
First Line	:	1122 PELHAM PARKWAY SOUTH
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1027
Country	:	US
Telephone Number	:	718-829-0652
Fax Number	:	718-228-0136

Provider Business Practice Location Address
First Line	:	1122 PELHAM PARKWAY SOUTH
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1027
Country	:	US
Telephone Number	:	718-829-0652
Fax Number	:	718-228-0136

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/13/2010

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