MEDICARE: ANNA SUSAN 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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	CSW008827	GA

General Provider Information

NPI Number	:	1891251005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA SUSAN RIVERA LCSW

Provider Business Mailing Address
First Line	:	171 ARBOR VILLAGE DR
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-5012
Country	:	US
Telephone Number	:	716-930-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 ARBOR VILLAGE DR
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-5012
Country	:	US
Telephone Number	:	716-930-1800
Fax Number	:

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

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	10/24/2023

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