Healthcare Provider Details

I. General information

NPI: 1952227407
Provider Name (Legal Business Name): JORGELUIS RIVERA RCSWI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 VOTAW RD
APOPKA FL
32703-4673
US

IV. Provider business mailing address

1529 VOTAW RD
APOPKA FL
32703-4673
US

V. Phone/Fax

Practice location:
  • Phone: 386-589-1591
  • Fax:
Mailing address:
  • Phone: 386-589-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW23036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: