MEDICARE: LURIS COLL RIVERA MSW, 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

General Provider Information

NPI Number	:	1659663326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LURIS COLL RIVERA MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1363
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-1363
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 W PARK AVE UNIT 1363
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-6257
Country	:	US
Telephone Number	:	313-583-9144
Fax Number	:

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

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	03/12/2024

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