Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 106S00000X | Behavior Technician |
NPI | 1124593843 |
---|---|
Provider Name | Chris Rivera-Jinez |
First Address | Hialeah, FL 33018-6509 |
Second Address | Miami, FL 33193-5827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2018 |
Last Update Date | 04/12/2020 |