Individual
AMANDA ALICIA RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
148 WILSHIRE BLVD STE 148, CASSELBERRY, FL 32707-5372
(321) 972-4039
Mailing address
1130 MEADOW LAKE WAY APT 206, WINTER SPRINGS, FL 32708-5279
(646) 659-1818
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
FL
Enumeration date
03/19/2018
Last updated
01/04/2019
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