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General NPI Number Information
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NPI Number | 1457193724
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Entity Type | Individual
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Provider Name | CARLOS ALFONSO RIVERA COUNSELOR
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Gender | Male
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Dates
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Enumeration Date | 06/08/2024
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Last Update Date | 06/08/2024
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Provider Practice Location Address
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Address Line | 2643 SW 187TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33029-2440
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Country | US
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Telephone | 954-662-1806
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Fax |
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Provider Business Mailing Address
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Address Line | 2643 SW 187TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33029-2440
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Country | US
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Telephone | 954-662-1806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAADC-05-20-1473
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License Number State | PR
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