Provider Demographics
NPI:1659102143
Name:RIVAS, JENNI LYNN (MS)
Entity type:Individual
Prefix:
First Name:JENNI
Middle Name:LYNN
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 PALM TRACE LANDINGS DR APT 1420
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-6809
Mailing Address - Country:US
Mailing Address - Phone:954-632-2664
Mailing Address - Fax:
Practice Address - Street 1:15200 S JOG RD STE 303
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1249
Practice Address - Country:US
Practice Address - Phone:561-774-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health