Provider Demographics
NPI:1598549099
Name:RIVERA, COURTNEY LAUREN
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LAUREN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9943 JONAS SALK DR APT 220
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7448
Mailing Address - Country:US
Mailing Address - Phone:813-625-6560
Mailing Address - Fax:
Practice Address - Street 1:5814 OLD PASCO RD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4011
Practice Address - Country:US
Practice Address - Phone:484-832-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician