Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003149246 |
---|---|
Provider Name | Susan C Rivera |
First Address | Albuquerque, NM 87120-1213 |
Second Address | Santa Fe, NM 87507-4851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2009 |
Last Update Date | 25/06/2015 |