Provider Demographics
NPI:1801158043
Name:RIVERA MELENDEZ, MARJORIE EDD (RCSWI)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:EDD
Last Name:RIVERA MELENDEZ
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 GLADES CIR
Mailing Address - Street 2:#228
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7100
Mailing Address - Country:US
Mailing Address - Phone:407-314-4978
Mailing Address - Fax:
Practice Address - Street 1:1010 EXECUTIVE CENTER DR
Practice Address - Street 2:#100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3529
Practice Address - Country:US
Practice Address - Phone:321-281-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 6394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker