Provider Demographics
NPI:1245549104
Name:RIVERA, ANTHONY C (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:C
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 HIGHLAND CREEK CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9812
Mailing Address - Country:US
Mailing Address - Phone:440-241-9548
Mailing Address - Fax:
Practice Address - Street 1:5151 MONROE ST STE 250E
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3469
Practice Address - Country:US
Practice Address - Phone:419-482-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
OH7007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty