Provider Demographics
NPI:1619639283
Name:RIVERA, ENRIQUE A
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3730
Mailing Address - Country:US
Mailing Address - Phone:407-847-4152
Mailing Address - Fax:
Practice Address - Street 1:3062 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1544
Practice Address - Country:US
Practice Address - Phone:407-705-7874
Practice Address - Fax:407-418-1160
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health