Healthcare Provider Details

I. General information

NPI: 1780886937
Provider Name (Legal Business Name): DEBORAH RIVERA PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 E OAK ST
KISSIMMEE FL
34744-4580
US

IV. Provider business mailing address

3002 WHIMSICAL LN
KISSIMMEE FL
34744-8572
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-0533
  • Fax: 407-518-1730
Mailing address:
  • Phone: 407-201-2315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10607
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1033
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: