Active NPI
Jeanette Rivera, LCSW
- Clinical Social Worker
- Monroe, NY
National Provider Identifier
1043777816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 087996
- Practice address
- 360 State Route 17M Ste 4
Monroe, NY 10950-3444 - Phone
- (845) 547-0479
- NPI assigned
- Feb 27, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 087996 | NY | Primary |
Addresses
Primary practice location
360 State Route 17M Ste 4
Monroe, NY 10950-3444
Mailing address
3 Dawn CT
Chester, NY 10918-2518
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 30, 2023 through Jun 30, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 087996 | NY | MD | Community/Behavioral Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551225600000",
"number": "1043777816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 DAWN CT",
"city": "CHESTER",
"state": "NY",
"postal_code": "109182518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 STATE ROUTE 17M STE 4",
"city": "MONROE",
"state": "NY",
"postal_code": "109503444",
"telephone_number": "845-547-0479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "JEANETTE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-27",
"last_updated": "2019-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "087996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.