Provider Demographics
NPI:1821407776
Name:RIVERA, YAZNELLY S
Entity Type:Individual
Prefix:
First Name:YAZNELLY
Middle Name:S
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 1:2307 GREENWILLOW DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7572
Mailing Address - Country:US
Mailing Address - Phone:407-508-7374
Mailing Address - Fax:407-522-4671
Practice Address - Street 1:1800 MERCY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-5646
Practice Address - Country:US
Practice Address - Phone:407-875-3700
Practice Address - Fax:407-522-4671
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X, 171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health