Provider Demographics
NPI:1558409789
Name:RIVERA, MARIA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 COLORADO AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3031
Mailing Address - Country:US
Mailing Address - Phone:772-220-3439
Mailing Address - Fax:
Practice Address - Street 1:735 COLORADO AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3031
Practice Address - Country:US
Practice Address - Phone:772-220-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764118400Medicaid