Provider Demographics
NPI:1043379696
Name:RIVERA, MICHELLE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 CROSSHAIR CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7405
Mailing Address - Country:US
Mailing Address - Phone:321-662-6890
Mailing Address - Fax:
Practice Address - Street 1:40 WATERSIDE PLZ APT 21A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2633
Practice Address - Country:US
Practice Address - Phone:321-662-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical