Provider Demographics
NPI:1316618721
Name:RIVERA, ADIAM (RBT-20-143631)
Entity type:Individual
Prefix:
First Name:ADIAM
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RBT-20-143631
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 NW 7TH ST APT 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2193
Mailing Address - Country:US
Mailing Address - Phone:786-714-3384
Mailing Address - Fax:
Practice Address - Street 1:155 E 6TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4847
Practice Address - Country:US
Practice Address - Phone:786-714-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL110651400106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician