Provider Demographics
NPI:1770917080
Name:RIVERA, MICHELLE (MFT PERMIT PENDING)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MFT PERMIT PENDING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 BRUCKNER BLVD
Mailing Address - Street 2:APT. 2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1301
Mailing Address - Country:US
Mailing Address - Phone:347-398-0663
Mailing Address - Fax:
Practice Address - Street 1:579 COURTLANDT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5013
Practice Address - Country:US
Practice Address - Phone:718-485-2100
Practice Address - Fax:718-485-2101
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist