Individual
ANGEL LUIS RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
3940 BROADWAY, NEW YORK, NY 10032-1534
(212) 781-5500
(212) 927-6089
Mailing address
311 E 175TH ST, BRONX, NY 10457-5859
(718) 960-7605
(718) 583-6439
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
115870
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115870
LICENSE REGISTRATION
NY
01
—
862691607
DRIVER LICENSE
NY
Enumeration date
12/06/2022
Last updated
12/06/2022
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