Provider Demographics
NPI:1114207644
Name:RIVERA, JESSICA ESTHER (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ESTHER
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14601 SW 29TH ST
Mailing Address - Street 2:SUITE 101 B
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4714
Mailing Address - Country:US
Mailing Address - Phone:305-582-8809
Mailing Address - Fax:786-345-0776
Practice Address - Street 1:14601 HOTEL ROAD
Practice Address - Street 2:SUITE 101B
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4711
Practice Address - Country:US
Practice Address - Phone:954-933-8299
Practice Address - Fax:786-345-0776
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8359103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist