Healthcare Provider Details

I. General information

NPI: 1013871458
Provider Name (Legal Business Name): LADY ELVA RUBINO OLIVO LCSW, CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11215 CREEK HAVEN DR
RIVERVIEW FL
33569-6209
US

IV. Provider business mailing address

11215 CREEK HAVEN DR
RIVERVIEW FL
33569-6209
US

V. Phone/Fax

Practice location:
  • Phone: 813-410-2039
  • Fax:
Mailing address:
  • Phone: 813-410-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: