Provider Demographics
NPI:1164426557
Name:RIVET, DENISE MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARY
Last Name:RIVET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:GUZMAN
Other - Last Name:RIVET-GLAMUZINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:105 S RIVERSIDE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4321
Mailing Address - Country:US
Mailing Address - Phone:321-733-2299
Mailing Address - Fax:321-733-7515
Practice Address - Street 1:105 S RIVERSIDE DR
Practice Address - Street 2:STE 100
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4321
Practice Address - Country:US
Practice Address - Phone:321-733-2299
Practice Address - Fax:321-733-7515
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW49421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5572Medicare ID - Type Unspecified