Provider Demographics
NPI:1578377420
Name:RIVERA, JENNIFER INEZ
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:INEZ
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 ATLANTIC AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-4289
Mailing Address - Country:US
Mailing Address - Phone:929-625-0158
Mailing Address - Fax:
Practice Address - Street 1:1854 HYLAN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2119
Practice Address - Country:US
Practice Address - Phone:929-625-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator