Provider Demographics
NPI:1912395732
Name:RIVERA, ELBA (MA)
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 CONLEY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3116
Mailing Address - Country:US
Mailing Address - Phone:321-297-7098
Mailing Address - Fax:407-964-1274
Practice Address - Street 1:6900 S ORANGE BLOSSOM TRL
Practice Address - Street 2:#402
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5745
Practice Address - Country:US
Practice Address - Phone:407-382-9079
Practice Address - Fax:407-964-1274
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor