Provider Demographics
NPI:1669360517
Name:RIVERA, JENNA DAWN (MED LBS)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:DAWN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MED LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 MONACACY RD
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-1457
Mailing Address - Country:US
Mailing Address - Phone:917-698-1026
Mailing Address - Fax:
Practice Address - Street 1:224 NAZARETH PIKE UNIT 22A
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9084
Practice Address - Country:US
Practice Address - Phone:610-365-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007809103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst