Provider Demographics
NPI:1184990301
Name:RIVERA, JOSE L, (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L,
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13816 CHIHULY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-6100
Mailing Address - Country:US
Mailing Address - Phone:407-240-1182
Mailing Address - Fax:
Practice Address - Street 1:829 E OAK ST STE C
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5829
Practice Address - Country:US
Practice Address - Phone:386-574-7417
Practice Address - Fax:888-217-4124
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health