Provider Demographics
NPI:1578854741
Name:RIVERA, LILY ANN (MA, CAP, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:ANN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA, CAP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2344
Mailing Address - Country:US
Mailing Address - Phone:407-846-0023
Mailing Address - Fax:407-933-7890
Practice Address - Street 1:206 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2344
Practice Address - Country:US
Practice Address - Phone:407-846-0023
Practice Address - Fax:407-933-7890
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health