Provider Demographics
NPI:1164592564
Name:RIVERA, ARACELI IV
Entity Type:Individual
Prefix:
First Name:ARACELI
Middle Name:
Last Name:RIVERA
Suffix:IV
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 1:600 N THACKER AVE
Mailing Address - Street 2:SUITE D28
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4892
Mailing Address - Country:US
Mailing Address - Phone:888-607-0005
Mailing Address - Fax:407-348-8883
Practice Address - Street 1:600 N THACKER AVE
Practice Address - Street 2:SUITE D28
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4892
Practice Address - Country:US
Practice Address - Phone:888-607-0005
Practice Address - Fax:407-348-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW2144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3393Medicare ID - Type Unspecified