Provider Demographics
NPI:1992316723
Name:RIVERO, YENIFER CATI (R162963829270)
Entity type:Individual
Prefix:MISS
First Name:YENIFER
Middle Name:CATI
Last Name:RIVERO
Suffix:
Gender:F
Credentials:R162963829270
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20621 SW 116TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1037
Mailing Address - Country:US
Mailing Address - Phone:786-314-3088
Mailing Address - Fax:
Practice Address - Street 1:18951 SW 106TH AVE STE 105-106
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7668
Practice Address - Country:US
Practice Address - Phone:305-233-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCC10609106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician