Provider Demographics
NPI:1669603726
Name:RIVERA, MARI DE LOS ANGELES (CHT)
Entity type:Individual
Prefix:MISS
First Name:MARI DE LOS ANGELES
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17090 COLLINS AVE APT B206
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3603
Mailing Address - Country:US
Mailing Address - Phone:954-618-7146
Mailing Address - Fax:
Practice Address - Street 1:17090 COLLINS AVE APT B206
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3603
Practice Address - Country:US
Practice Address - Phone:954-618-7146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL061809-7146101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor