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General NPI Number Information
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NPI Number | 1801693064
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Entity Type | Individual
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Provider Name | MICHELLE BAKER RIVERA LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 1251 N STONE ST
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City | DELAND
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State | FL
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Zip | 32720-2584
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Country | US
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Telephone | 800-539-4228
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Fax | 386-236-3183
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Provider Business Mailing Address
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Address Line | 150 MAGNOLIA AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4304
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Country | US
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Telephone | 386-236-3225
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3927
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License Number State | FL
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