Provider Demographics
NPI:1174358782
Name:RIVERA, HEATHER L (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:L
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:GUZIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:7307 FOREST MERE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8632
Mailing Address - Country:US
Mailing Address - Phone:918-340-8656
Mailing Address - Fax:
Practice Address - Street 1:109 N OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4629
Practice Address - Country:US
Practice Address - Phone:813-819-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW234521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty