Provider Demographics
NPI:1811423288
Name:RIVERAS, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RIVERAS
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 1:7952 W 29TH WAY
Mailing Address - Street 2:APT102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7266
Mailing Address - Country:US
Mailing Address - Phone:305-542-3169
Mailing Address - Fax:305-971-3095
Practice Address - Street 1:11025 SW 84TH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3857
Practice Address - Country:US
Practice Address - Phone:305-971-1230
Practice Address - Fax:305-971-3095
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician