Provider Demographics
NPI:1083281539
Name:RIVAS, LORENZO (RBT)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 COMMUNITY DR APT 165
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5587
Mailing Address - Country:US
Mailing Address - Phone:214-715-4249
Mailing Address - Fax:
Practice Address - Street 1:2825 VALLEY VIEW LN
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4955
Practice Address - Country:US
Practice Address - Phone:214-736-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician