Provider Demographics
NPI:1306650056
Name:HERRO RIVERO, LORENA D
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:D
Last Name:HERRO RIVERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 BOSTICK CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6203
Mailing Address - Country:US
Mailing Address - Phone:786-564-5575
Mailing Address - Fax:
Practice Address - Street 1:4617 BOSTICK CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6203
Practice Address - Country:US
Practice Address - Phone:786-564-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-395528106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician