Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | SW133151 | PA |
NPI | 1003303199 |
---|---|
Provider Name | Shana E Rivera |
First Address | Hershey, PA 17033-0858 |
Second Address | Harrisburg, PA 17110-1904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2018 |
Last Update Date | 16/04/2018 |