Provider Demographics
NPI:1871684399
Name:RIVERA TORO, JOAN M (BCBA, CCC-SLP, MS)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:M
Last Name:RIVERA TORO
Suffix:
Gender:F
Credentials:BCBA, CCC-SLP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SYKES CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9178
Mailing Address - Country:US
Mailing Address - Phone:787-413-8068
Mailing Address - Fax:
Practice Address - Street 1:110 E BROWARD BLVD STE 2400
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3504
Practice Address - Country:US
Practice Address - Phone:561-849-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR456235Z00000X
PR1-16-21946103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1-16-21946OtherTRICARE OVERSEAS SOS
PR73439024OtherTPIN- CENTRAL CONTRACTOR