Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 075211 | NY |
NPI | 1003182635 |
---|---|
Provider Name | Loida Luisa Reyes-Rivera |
First Address | Bronx, NY 10457-7606 |
Second Address | Bronx, NY 10457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 28/03/2012 |