Provider Demographics
NPI:1124328885
Name:RIVERA, IDA (MA)
Entity type:Individual
Prefix:MS
First Name:IDA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 SARNOW DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-7531
Mailing Address - Country:US
Mailing Address - Phone:407-921-0669
Mailing Address - Fax:407-261-0523
Practice Address - Street 1:150 SPARTAN DR
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3468
Practice Address - Country:US
Practice Address - Phone:407-331-8002
Practice Address - Fax:407-261-0523
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor