Provider Demographics
NPI:1174772867
Name:RIVERA, TAMMY J (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:J
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 RANCHLANDS
Mailing Address - Street 2:
Mailing Address - City:BUSHKILL
Mailing Address - State:PA
Mailing Address - Zip Code:18324-8702
Mailing Address - Country:US
Mailing Address - Phone:570-828-2388
Mailing Address - Fax:570-828-2388
Practice Address - Street 1:273 RANCHLANDS
Practice Address - Street 2:
Practice Address - City:BUSHKILL
Practice Address - State:PA
Practice Address - Zip Code:18324-8702
Practice Address - Country:US
Practice Address - Phone:570-828-2388
Practice Address - Fax:570-828-2388
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0600021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical