Provider Demographics
NPI:1669939567
Name:RIVERA, BETSY (CDCA)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39500 EUCLID AVE WILLOUGBHY OHIO 44095
Mailing Address - Street 2:35900 EUCLID AVE WILLOUGHBY OHIO 44095
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44095
Mailing Address - Country:US
Mailing Address - Phone:440-602-3951
Mailing Address - Fax:440-953-3277
Practice Address - Street 1:39500 EUCLID AVE WILLOUGBHY OHIO 44095
Practice Address - Street 2:35900 EUCLID AVE WILLOUGHBY OHIO 44095
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44095
Practice Address - Country:US
Practice Address - Phone:440-602-3951
Practice Address - Fax:440-953-3277
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100388101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)