MEDICARE: MAITEE HERNANDEZ RIVERO CBHCM

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	171M00000X	Case Manager/Care Coordinator	CBHCMP100522	FL
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CBHCMP100522	OTHER	FL	CBHCM CERTIFICATION
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255955712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAITEE HERNANDEZ RIVERO CBHCM

Provider Business Mailing Address
First Line	:	6520 SW 49TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6136
Country	:	US
Telephone Number	:	786-316-7437
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 SW 49TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6136
Country	:	US
Telephone Number	:	786-316-7437
Fax Number	:

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

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	11/05/2022

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