Healthcare Provider Details

I. General information

NPI: 1457912560
Provider Name (Legal Business Name): LAUREN E RIVERA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 N WICKHAM RD UNIT 107A-260
MELBOURNE FL
32935-2485
US

IV. Provider business mailing address

10850 S US HIGHWAY 1 STE 2
PORT ST LUCIE FL
34952-6407
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 772-463-0444
  • Fax: 722-219-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-68062
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43608
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43608
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: