Provider Demographics
NPI:1740976216
Name:RIVERON MONTERO, MARIAM DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:DE LA CARIDAD
Last Name:RIVERON MONTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W AVENIDA DEL RIO
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-2321
Mailing Address - Country:US
Mailing Address - Phone:689-205-1982
Mailing Address - Fax:
Practice Address - Street 1:1060 MAITLAND CENTER COMMONS BLVD STE 225
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7202
Practice Address - Country:US
Practice Address - Phone:386-320-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-268739106S00000X
FL0-25-16236103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician