Provider Demographics
NPI:1225413842
Name:RIVAS, YIDRI JANETTE
Entity Type:Individual
Prefix:
First Name:YIDRI
Middle Name:JANETTE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YIDRI
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS PSYCHOLOGY
Mailing Address - Street 1:6169 METRO WEST BLVD # 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2998
Mailing Address - Country:US
Mailing Address - Phone:321-946-9912
Mailing Address - Fax:
Practice Address - Street 1:6169 METROWEST BLVD UNIT 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2998
Practice Address - Country:US
Practice Address - Phone:407-587-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health