Provider Demographics
NPI:1942900386
Name:RIVERO, GRETER
Entity Type:Individual
Prefix:
First Name:GRETER
Middle Name:
Last Name:RIVERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10520 NW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5940
Mailing Address - Country:US
Mailing Address - Phone:305-364-5182
Mailing Address - Fax:305-456-6243
Practice Address - Street 1:10520 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5940
Practice Address - Country:US
Practice Address - Phone:305-364-5182
Practice Address - Fax:305-456-6243
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0105589104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty