Provider Demographics
NPI:1689816712
Name:RIVERA, CLARA I
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:I
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 1:2165 BAY DR APT 18
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3472
Mailing Address - Country:US
Mailing Address - Phone:786-556-3181
Mailing Address - Fax:
Practice Address - Street 1:2165 BAY DR APT 18
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3472
Practice Address - Country:US
Practice Address - Phone:786-556-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst