Individual
CHARLES RAYMOND DE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, ABD
Contact information
Practice address
36000 DARNALL LOOP, FORT HOOD, TX 76544-5095
(254) 288-5602
Mailing address
36000 DARNALL LOOP, FORT HOOD, TX 76544-5095
(254) 288-5602
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
S11224
TX
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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