Individual
JEROLD RIVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
770 GRAND BLVD, DEER PARK, NY 11729-5750
(631) 392-4357
Mailing address
332 HOLBROOK RD, LAKE RONKONKOMA, NY 11779-1815
(631) 504-7672
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/10/2024
Last updated
05/10/2024
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