Provider Demographics
NPI:1386662401
Name:RIVERA, BRENDA IRIS (PSY D)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:IRIS
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 SW 113TH PL
Mailing Address - Street 2:SUITE #112
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3283
Mailing Address - Country:US
Mailing Address - Phone:786-269-5181
Mailing Address - Fax:305-234-4571
Practice Address - Street 1:10850 SW 113TH PL
Practice Address - Street 2:SUITE #112
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3283
Practice Address - Country:US
Practice Address - Phone:786-269-5181
Practice Address - Fax:305-234-4571
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical