Provider Demographics
NPI:1609692318
Name:RIVERON VALLE, FREDY (RBT)
Entity type:Individual
Prefix:
First Name:FREDY
Middle Name:
Last Name:RIVERON VALLE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10513 WEEPING WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5125
Mailing Address - Country:US
Mailing Address - Phone:786-956-8641
Mailing Address - Fax:
Practice Address - Street 1:2700 N MACDILL AVE STE 206
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2273
Practice Address - Country:US
Practice Address - Phone:813-644-6538
Practice Address - Fax:813-200-3609
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician