Provider Demographics
NPI:1366141566
Name:RIVERA, JASON JOSHUA (LMSW-CLINICAL)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JOSHUA
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LMSW-CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CALKINS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4210
Mailing Address - Country:US
Mailing Address - Phone:585-463-2646
Mailing Address - Fax:
Practice Address - Street 1:260 CALKINS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4210
Practice Address - Country:US
Practice Address - Phone:585-463-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011090321041C0700X
NY101431-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker