Provider Demographics
NPI:1548977879
Name:RIVERA, LUIS (LMHC, LMFT, CASAC)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LMHC, LMFT, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N VILLAGE AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4610
Mailing Address - Country:US
Mailing Address - Phone:516-536-2797
Mailing Address - Fax:516-536-7771
Practice Address - Street 1:45 N VILLAGE AVE STE 2B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4610
Practice Address - Country:US
Practice Address - Phone:516-536-2797
Practice Address - Fax:516-536-7771
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000511101YM0800X
NY12504101YA0400X
NY000660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist