MEDICARE: YESSICA RIVERA RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	106E00000X	Assistant Behavior Analyst	FL
2	106S00000X	Behavior Technician
3	106S00000X	Behavior Technician	FL

General Provider Information

NPI Number	:	1013739945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESSICA RIVERA RIVERA

Provider Business Mailing Address
First Line	:	201 FIREBALL LN
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-6536
Country	:	US
Telephone Number	:	239-240-4929
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 21ST ST SW
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33976-3644
Country	:	US
Telephone Number	:	239-240-4929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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Directions to “ YESSICA RIVERA RIVERA ” Practice Location

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