Provider Demographics
NPI:1336910975
Name:RIVERA BONELLI, EDWIN M
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:M
Last Name:RIVERA BONELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:EDWIN
Other - Middle Name:M
Other - Last Name:RIVERA BONELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7726 WINEGARD RD STE 53
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7147
Mailing Address - Country:US
Mailing Address - Phone:407-900-5278
Mailing Address - Fax:
Practice Address - Street 1:7726 WINEGARD RD STE 53
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7147
Practice Address - Country:US
Practice Address - Phone:407-900-5278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker