Ian Hugh Adon Rivera, LCSW, MCAP
Social Worker, Clinical in Brandon, FL. Individual provider (NPI-1).
NPI number1164061040
StatusActive
Last updated in NPPESMar 21, 2020
Details
- NPI
- 1164061040
- Entity type
- Individual (NPI-1)
- Name
- Ian Hugh Adon Rivera
- Credential
- LCSW, MCAP
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 24, 2019
- Certification date
- Mar 21, 2020
- Last updated
- Mar 21, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | SW17093 | FL | Yes |
Practice location
1047 E Brandon BlvdBrandon, FL 33511-5515
Phone 414-312-1010
Mailing address
12745 Lemon Pepper DrRiverview, FL 33578-7585
Phone 414-312-1010
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