Provider Demographics
NPI:1124463294
Name:GAVITT RIVERA, LAUREN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:GAVITT RIVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3114
Mailing Address - Country:US
Mailing Address - Phone:352-573-8000
Mailing Address - Fax:
Practice Address - Street 1:306 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3213
Practice Address - Country:US
Practice Address - Phone:727-712-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL168011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical