NPIMap

Organization Active NPI

Revibe Therapy PLLC

Doing business as Revibe Therapy

  • Clinical Social Worker
  • Orlando, FL
National Provider Identifier
1457919516
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
REVIBE THERAPY PLLC
Doing business as
Revibe Therapy
Practice address
6900 Tavistock Lakes Blvd Ste 400
Orlando, FL 32827-7593
Phone
(407) 801-2191
NPI assigned
Jun 4, 2019
Last updated
May 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jose Miguel De la Cruz Jr., LCSWNPI 1629635073
Title
Hypnotherapist/ Psychotherapist
Phone
(407) 801-2191

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

6900 Tavistock Lakes Blvd Ste 400
Orlando, FL 32827-7593

Mailing address

11901 Landing Point Loop
Orlando, FL 32832-5904
Phone (407) 801-2191

Other identifiers 1

IdentifierTypeStateIssuer
1629635073MedicaidFL

Other names 1

  • Revibe Therapy Doing business as

National Provider Directory

National Provider Directory

Locations

1850 Lee Rd
Ste 122A
Winter Park, FL 32789
Phone (407) 295-2442

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1457919516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11901 LANDING POINT LOOP",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328325904",
            "telephone_number": "407-801-2191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 TAVISTOCK LAKES BLVD STE 400",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328277593",
            "telephone_number": "407-801-2191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIBE THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-04",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A",
        "authorized_official_last_name": "DE LA CRUZ",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "MIGUEL",
        "authorized_official_title_or_position": "HYPNOTHERAPIST/ PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "407-801-2191",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629635073",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revibe Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revibe Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.