Healthcare Provider Details

I. General information

NPI: 1447375308
Provider Name (Legal Business Name): LUIS O. RIVERA-GONZALEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 US HIGHWAY 98 N
LAKELAND FL
33809-3854
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD
LAKELAND FL
33805-4543
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-1222
  • Fax: 863-603-6546
Mailing address:
  • Phone: 863-687-1100
  • Fax: 863-603-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW12254
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: