Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | NY |
NPI | 1003054487 |
---|---|
Provider Name | Ms. Iris Rivera |
First Address | Milford, PA 18337-9703 |
Second Address | Bronx, NY 10456-4037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2009 |
Last Update Date | 23/01/2009 |