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NPI Code Detail

MEDICARE: MS. LUNA MICHELLE RIVERA MA, BCBA

MEDICARE: MS. LUNA MICHELLE RIVERA MA, BCBA
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
1101YM0800XMental Health CounselorIMH 8672FL
2103K00000XBehavior Analyst1-15-17923FL

General Provider Information

NPI Number : 1932481512
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LUNA MICHELLE RIVERA MA, BCBA
Provider Business Mailing Address
First Line : 5165 ADANSON ST
Second Line :
City : ORLANDO
State : FL
Zip : 32804-1331
Country : US
Telephone Number : 407-408-7402
Fax Number : 407-627-0303
Provider Business Practice Location Address
First Line : 5165 ADANSON ST
Second Line :
City : ORLANDO
State : FL
Zip : 32804-1331
Country : US
Telephone Number : 407-408-7402
Fax Number : 407-627-0303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2011
Last Update Date : 04/07/2022

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