Provider Demographics
NPI:1144616517
Name:RIVERA-TIGHE, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:RIVERA-TIGHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 WETHERSFIELD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1438
Mailing Address - Country:US
Mailing Address - Phone:860-236-4511
Mailing Address - Fax:860-231-8449
Practice Address - Street 1:331 WETHERSFIELD AVE STE 2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1438
Practice Address - Country:US
Practice Address - Phone:860-236-4511
Practice Address - Fax:860-231-8449
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional