Provider Demographics
NPI:1548479454
Name:RIVERA, EMMY (LCSW)
Entity type:Individual
Prefix:
First Name:EMMY
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 POWELL AVE
Mailing Address - Street 2:F-21
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5100
Mailing Address - Country:US
Mailing Address - Phone:917-806-7912
Mailing Address - Fax:
Practice Address - Street 1:119 W 124TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4920
Practice Address - Country:US
Practice Address - Phone:917-386-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039281-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)