Provider Demographics
NPI:1942813043
Name:RIVERA GOPEZ, JESEY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESEY
Middle Name:
Last Name:RIVERA GOPEZ
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2703
Mailing Address - Country:US
Mailing Address - Phone:818-726-6749
Mailing Address - Fax:
Practice Address - Street 1:525 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-2703
Practice Address - Country:US
Practice Address - Phone:608-385-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst