Organization
SELF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS RIVERA (COUNSELOR)
(413) 244-5624
Entity
Organization
Contact information
Practice address
19 MERRICK AVE APT 1, SPRINGFIELD, MA 01109-4324
(413) 244-5624
Mailing address
19 MERRICK AVE, SPRINGFIELD, MA 01109-4324
(413) 244-5624
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/05/2016
Last updated
07/05/2016
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