MEDICARE: MS. EMILY GRACE RIVERA MS

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	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1366015364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY GRACE RIVERA MS

Provider Business Mailing Address
First Line	:	111 W MAGNOLIA AVE
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4130
Country	:	US
Telephone Number	:	407-215-0095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 HIMALAYAN CT
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-5676
Country	:	US
Telephone Number	:	754-202-2565
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	03/31/2026

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