Provider Demographics
NPI:1295036929
Name:WALTER, ILIAMARIS RIVERA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ILIAMARIS
Middle Name:RIVERA
Last Name:WALTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2006
Mailing Address - Country:US
Mailing Address - Phone:954-649-6014
Mailing Address - Fax:
Practice Address - Street 1:3325 S UNIVERSITY DR
Practice Address - Street 2:SUITE 209
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2006
Practice Address - Country:US
Practice Address - Phone:954-649-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000604106H00000X
FLMT 2676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist