Provider Demographics
NPI:1609511658
Name:RIVAS, IVON ANGELY
Entity Type:Individual
Prefix:
First Name:IVON
Middle Name:ANGELY
Last Name:RIVAS
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 1:13130 EMERALD COAST DR APT 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4725
Mailing Address - Country:US
Mailing Address - Phone:321-246-6490
Mailing Address - Fax:
Practice Address - Street 1:13130 EMERALD COAST DR APT 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4725
Practice Address - Country:US
Practice Address - Phone:321-246-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health