Provider Demographics
NPI:1548310360
Name:RIVERA, JENNIFER S (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:S
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:KOBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1132 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-2114
Mailing Address - Country:US
Mailing Address - Phone:719-306-5001
Mailing Address - Fax:
Practice Address - Street 1:1132 KEITH DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-2114
Practice Address - Country:US
Practice Address - Phone:719-306-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992912104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker