Individual
KEISA RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
245 EUSTIS ST, ROXBURY, MA 02119-2826
(617) 445-1123
Mailing address
302 EUSTIS ST, ROXBURY, MA 02119-3800
(617) 445-1123
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S000000
NOT LICENSED CASE MANAGER
MA
Enumeration date
11/23/2015
Last updated
11/23/2015
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