Provider Demographics
NPI:1932693660
Name:RIVERA AMIN, STEPHANY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANY
Middle Name:
Last Name:RIVERA AMIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 SW ANCONA RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1989
Mailing Address - Country:US
Mailing Address - Phone:561-460-3649
Mailing Address - Fax:
Practice Address - Street 1:10542 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5603
Practice Address - Country:US
Practice Address - Phone:561-460-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-16
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW173231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical