Provider Demographics
NPI:1932481512
Name:RIVERA, LUNA MICHELLE (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:LUNA
Middle Name:MICHELLE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5165 ADANSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1331
Mailing Address - Country:US
Mailing Address - Phone:407-408-7402
Mailing Address - Fax:407-627-0303
Practice Address - Street 1:5165 ADANSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1331
Practice Address - Country:US
Practice Address - Phone:407-408-7402
Practice Address - Fax:407-627-0303
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 8672101YM0800X
FL1-15-17923103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health