Provider Demographics
NPI:1255955712
Name:HERNANDEZ RIVERO, MAITEE (CBHCM)
Entity type:Individual
Prefix:
First Name:MAITEE
Middle Name:
Last Name:HERNANDEZ RIVERO
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:MAITEE
Other - Middle Name:
Other - Last Name:HERNANDEZ RIVERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIOR T
Mailing Address - Street 1:6520 SW 49TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6136
Mailing Address - Country:US
Mailing Address - Phone:786-316-7437
Mailing Address - Fax:
Practice Address - Street 1:6520 SW 49TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6136
Practice Address - Country:US
Practice Address - Phone:786-316-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMP100522171M00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCMP100522OtherCBHCM CERTIFICATION
FL108140000Medicaid