Provider Demographics
NPI:1851822308
Name:DOMINICA M. RIVERA LLC
Entity Type:Organization
Organization Name:DOMINICA M. RIVERA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-479-2320
Mailing Address - Street 1:7216 US HIGHWAY 301 N
Mailing Address - Street 2:ST. 104/105
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3462
Mailing Address - Country:US
Mailing Address - Phone:941-479-2320
Mailing Address - Fax:
Practice Address - Street 1:7216 US HIGHWAY 301 N
Practice Address - Street 2:ST. 104/105
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3462
Practice Address - Country:US
Practice Address - Phone:941-479-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13846251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health