MEDICARE: JANICE PEREZ RIVERA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor	MH23735	FL

General Provider Information

NPI Number	:	1104174093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE PEREZ RIVERA LMHC

Provider Business Mailing Address
First Line	:	10929 WHITECAP DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7177
Country	:	US
Telephone Number	:	727-277-2585
Fax Number	:	813-490-5495

Provider Business Practice Location Address
First Line	:	1211 TECH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7846
Country	:	US
Telephone Number	:	813-708-7869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/17/2024

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