Provider Demographics
NPI:1164036059
Name:RIVERA, DORELYS RAQUEL
Entity Type:Individual
Prefix:DR
First Name:DORELYS
Middle Name:RAQUEL
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 1:479 BASKING RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-1721
Mailing Address - Country:US
Mailing Address - Phone:787-319-6532
Mailing Address - Fax:
Practice Address - Street 1:479 BASKING RIDGE CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-1721
Practice Address - Country:US
Practice Address - Phone:787-319-6532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional