Provider Demographics
NPI:1255624078
Name:RIVERA, JOSE AUGUSTO (PHD, MA)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:AUGUSTO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2523 US HIGHWAY 27 S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9690
Mailing Address - Country:US
Mailing Address - Phone:863-452-0710
Mailing Address - Fax:863-452-0142
Practice Address - Street 1:2523 US HIGHWAY 27 S
Practice Address - Street 2:SUITE 130
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9690
Practice Address - Country:US
Practice Address - Phone:863-452-0710
Practice Address - Fax:863-452-0142
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor