MEDICARE: JOEFRED RIVERA

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	101YM0800X	Mental Health Counselor	4770	PR

General Provider Information

NPI Number	:	1588364012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEFRED RIVERA

Provider Business Mailing Address
First Line	:	PO BOX 184
Second Line	:
City	:	NAGUABO
State	:	PR
Zip	:	00718-0184
Country	:	US
Telephone Number	:	787-374-3596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 WELLS RD STE 1
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-6766
Country	:	US
Telephone Number	:	904-523-1287
Fax Number	:

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

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	02/18/2026

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Directions to “ JOEFRED RIVERA ” Practice Location

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