Provider Demographics
NPI:1144460148
Name:RIVERA, BRANDON (PHD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N PORTLAND AVE
Mailing Address - Street 2:RM 516
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2005
Mailing Address - Country:US
Mailing Address - Phone:718-260-7725
Mailing Address - Fax:
Practice Address - Street 1:PSC 41
Practice Address - Street 2:RAF LAKENHEATH
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464
Practice Address - Country:US
Practice Address - Phone:000-226-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling