Provider Demographics
NPI:1740221704
Name:DE LA RIVA, LILIA (SUPPORT COORDINATOR)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:DE LA RIVA
Suffix:
Gender:F
Credentials:SUPPORT COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 GRANGER AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2204
Mailing Address - Country:US
Mailing Address - Phone:407-301-0680
Mailing Address - Fax:407-933-4225
Practice Address - Street 1:2216 GRANGER AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2204
Practice Address - Country:US
Practice Address - Phone:407-301-0680
Practice Address - Fax:407-933-4225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker