Individual provider Active NPI

Edelmiro Rivera Jr., LCSW-R

  • Clinical Social Worker
  • Bronx, NY
National Provider Identifier
1932379153
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R--072576 Issued in NY
Practice address
781 E 142ND St
Bronx, NY 10454-1723
Phone
(718) 993-1400
Fax
(718) 993-0647
NPI assigned
Mar 4, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R--072576 NY Primary

Addresses

Primary practice location

781 E 142ND St
Bronx, NY 10454-1723

Mailing address

781 E 142ND St
Bronx, NY 10454-1723
Phone (718) 993-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R--072576NYMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204588800000",
    "number": "1932379153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 E 142ND ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104541723",
            "telephone_number": "718-993-1400",
            "fax_number": "718-993-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 E 142ND ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104541723",
            "telephone_number": "718-993-1400",
            "fax_number": "718-993-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "EDELMIRO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-04",
        "last_updated": "2008-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R--072576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.