Provider Demographics
NPI:1912793415
Name:RIVERO, KAREN MARIA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIA
Last Name:RIVERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17760 COMMONWEALTH AVE N
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-7650
Mailing Address - Country:US
Mailing Address - Phone:813-331-7770
Mailing Address - Fax:
Practice Address - Street 1:17760 COMMONWEALTH AVE N
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:FL
Practice Address - Zip Code:33868-7650
Practice Address - Country:US
Practice Address - Phone:813-331-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1077995106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician