Provider Demographics
NPI:1457193724
Name:RIVERA, CARLOS ALFONSO (COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ALFONSO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 SW 187TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2440
Mailing Address - Country:US
Mailing Address - Phone:954-662-1806
Mailing Address - Fax:
Practice Address - Street 1:2643 SW 187TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2440
Practice Address - Country:US
Practice Address - Phone:954-662-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCAADC-05-20-1473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)