Individual
JESSICA L RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 HIGH ST, SPRINGFIELD, MA 01105-1442
(413) 495-1500
Mailing address
54 PARK ST, STAFFORD SPRINGS, CT 06076
(508) 304-5301
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
091906
MASS HEALTH
—
Enumeration date
02/14/2019
Last updated
02/14/2019
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