Healthcare Provider Details

I. General information

NPI: 1346823630
Provider Name (Legal Business Name): WILLIAM RIVERO BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3669 SW 2ND AVE
GAINESVILLE FL
32607-2856
US

IV. Provider business mailing address

3661 CENTRAL AVE
FORT MYERS FL
33901-8218
US

V. Phone/Fax

Practice location:
  • Phone: 352-554-6164
  • Fax: 352-240-6876
Mailing address:
  • Phone: 239-245-8761
  • Fax: 239-689-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-15823
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-874138
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: