MEDICARE: MS. LAUREN GAVITT RIVERA LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	16801	FL

General Provider Information

NPI Number	:	1124463294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN GAVITT RIVERA LCSW

Provider Business Mailing Address
First Line	:	3919 TAMPA RD
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3114
Country	:	US
Telephone Number	:	352-573-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 HAMILTON AVE
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-3213
Country	:	US
Telephone Number	:	727-712-0039
Fax Number	:

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

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	05/17/2022

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