Provider Demographics
NPI:1053674366
Name:RIVERA, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 ARNOW AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3948
Mailing Address - Country:US
Mailing Address - Phone:718-597-5558
Mailing Address - Fax:718-823-5494
Practice Address - Street 1:2510 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-597-5558
Practice Address - Fax:718-823-5494
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator