Provider Demographics
NPI:1346083979
Name:RIVERA DURAN, EDNA LISETH
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:LISETH
Last Name:RIVERA DURAN
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 1:2484 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5743
Mailing Address - Country:US
Mailing Address - Phone:561-501-9224
Mailing Address - Fax:
Practice Address - Street 1:2484 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5743
Practice Address - Country:US
Practice Address - Phone:561-542-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician