Basic Information
| Provider Information | |||||||||
| NPI: | 1598307035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4381 BALD EAGLE PARK | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700725575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049138048 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5001 WESTBANK EXPY | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700722954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043498833 | ||||||||
| FaxNumber: | 5043498844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2019 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 12324 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.