MEDICARE: MR. CARLOS ALFONSO RIVERA COUNSELOR

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAADC-05-20-1473	PR

General Provider Information

NPI Number	:	1457193724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS ALFONSO RIVERA COUNSELOR

Provider Business Mailing Address
First Line	:	2643 SW 187TH AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-2440
Country	:	US
Telephone Number	:	954-662-1806
Fax Number	:

Provider Business Practice Location Address
First Line	:	2643 SW 187TH AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-2440
Country	:	US
Telephone Number	:	954-662-1806
Fax Number	:

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

Provider Enumeration Date	:	06/08/2024
Last Update Date	:	06/08/2024

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