Provider Demographics
NPI:1093154833
Name:HERNANDEZ RIVAS, ISMAEL ALBERTO (BS PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:ALBERTO
Last Name:HERNANDEZ RIVAS
Suffix:
Gender:M
Credentials:BS PSYCHOLOGY
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6169 METROWEST BLVD UNIT 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2998
Mailing Address - Country:US
Mailing Address - Phone:407-844-5281
Mailing Address - Fax:
Practice Address - Street 1:6169 METROWEST BLVD APT #108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2998
Practice Address - Country:US
Practice Address - Phone:407-844-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health