Individual
KATHLEEN RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17411 67TH AVE, FRESH MEADOWS, NY 11365-2006
(719) 939-3773
Mailing address
17411 67TH AVE, FRESH MEADOWS, NY 11365-2006
(719) 939-3773
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
079499
NY
Other
Enumeration date
11/01/2016
Last updated
11/01/2016
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