Provider Demographics
NPI:1447200811
Name:RIVERA, DARLENE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2102
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-2102
Mailing Address - Country:US
Mailing Address - Phone:954-907-8358
Mailing Address - Fax:
Practice Address - Street 1:401 S COUNTY RD # S2102
Practice Address - Street 2:3840 PGA BLVD, PALM BEACH GARDENS
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-8200
Practice Address - Country:US
Practice Address - Phone:561-966-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7152103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5920-AMedicare ID - Type Unspecified