Provider Demographics
NPI:1033988779
Name:RIVERA, MARIELYS
Entity Type:Individual
Prefix:
First Name:MARIELYS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIELYS
Other - Middle Name:
Other - Last Name:CIRILO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 SUNSET VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-2662
Mailing Address - Country:US
Mailing Address - Phone:863-458-1182
Mailing Address - Fax:
Practice Address - Street 1:476 CARDINAL CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4423
Practice Address - Country:US
Practice Address - Phone:407-785-8196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician