Healthcare Provider Details

I. General information

NPI: 1568108140
Provider Name (Legal Business Name): GRETEL RIVERA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2022
Last Update Date: 02/17/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST STE 114
MIAMI FL
33173-3038
US

IV. Provider business mailing address

4257 SW 129TH PL
MIAMI FL
33175-4044
US

V. Phone/Fax

Practice location:
  • Phone: 305-302-4776
  • Fax:
Mailing address:
  • Phone: 352-619-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: