Provider Demographics
NPI:1164809455
Name:GONZALEZ, CYNTHIA RIVERA (CAP)
Entity Type:Individual
Prefix:PROF
First Name:CYNTHIA
Middle Name:RIVERA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:PROF
Other - First Name:CICE
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAP
Mailing Address - Street 1:9858 CLINT MOORE RD STE C111-202
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1034
Mailing Address - Country:US
Mailing Address - Phone:786-472-0220
Mailing Address - Fax:
Practice Address - Street 1:9858 CLINT MOORE RD STE C111-202
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1034
Practice Address - Country:US
Practice Address - Phone:786-472-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0050962014101YA0400X
FLCAP0100514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)