Provider Demographics
NPI:1073175170
Name:RIVERA, LINA MARIA
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:MARIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 CALIBRE CREST PKWY APT 103
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3628
Mailing Address - Country:US
Mailing Address - Phone:407-574-9193
Mailing Address - Fax:
Practice Address - Street 1:566 CALIBRE CREST PKWY APT 103
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3628
Practice Address - Country:US
Practice Address - Phone:407-574-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation