Provider Demographics
NPI:1710772793
Name:RIVERO LA ROSA, ALIETTY
Entity type:Individual
Prefix:
First Name:ALIETTY
Middle Name:
Last Name:RIVERO LA ROSA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ALIETTY
Other - Middle Name:
Other - Last Name:RIVERO LA ROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 BARLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1432
Mailing Address - Country:US
Mailing Address - Phone:305-464-9511
Mailing Address - Fax:
Practice Address - Street 1:308 BARLOW AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1432
Practice Address - Country:US
Practice Address - Phone:305-464-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25426689106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician