Provider Demographics
NPI:1083311518
Name:RIVERO MARIN, NATHALY
Entity Type:Individual
Prefix:
First Name:NATHALY
Middle Name:
Last Name:RIVERO MARIN
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 1:3225 31ST ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-5702
Mailing Address - Country:US
Mailing Address - Phone:305-851-1092
Mailing Address - Fax:
Practice Address - Street 1:3225 31ST ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-5702
Practice Address - Country:US
Practice Address - Phone:305-851-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician