Provider Demographics
NPI:1447477278
Name:RIVERA, JOSE ENRIQUE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 WEST FOREST HILL BLVD.
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-793-7678
Mailing Address - Fax:561-793-9745
Practice Address - Street 1:10111 WEST FOREST HILL BLVD.
Practice Address - Street 2:SUITE 160
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-793-7678
Practice Address - Fax:561-793-9745
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6922103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical