Agustin Rivera, M.D; MC; CLERGY

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PHM 1453 Issued in FL

Practice address

115 E Lancaster Rd
Orlando, FL 32809-6689

Phone

(863) 582-9899

NPI assigned

Feb 25, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Skills 4 You Florida, LLC

  • General Practice Physician
  • Clermont, FL
  • NPI 1740630946

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1456358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554163200000",
    "number": "1508226101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17906 WOODCREST WAY",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347145906",
            "telephone_number": "863-420-9899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E LANCASTER RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328096689",
            "telephone_number": "863-582-9899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Lake Davenport Blvd Ste C",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "FL",
            "postal_code": "338979405",
            "country_code": "US",
            "telephone_number": "863-420-9899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "AGUSTIN",
        "name_prefix": "Dr.",
        "credential": "M.D; MC; CLERGY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-25",
        "last_updated": "2019-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "FL",
            "license": "1702-002",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "PR",
            "license": "557",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "PHM 1453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FUNCTIONAL ASSESSMENT RATING SCALE",
            "identifier": "805036272",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAUMATOLOGY",
            "identifier": "1001A-1005",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHILDREN'S FUNCTIONAL ASSESMENT RATING SCALE",
            "identifier": "802042738",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SEXUAL ASSAULT FORENSIC EXAMINER TRAINING",
            "identifier": "CEP 15893",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARRIAGE AND FAMILY COUNSELING",
            "identifier": "MFT 557",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL DOCTOR",
            "identifier": "XXXX",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALIFIED SUPERVISOR TRAINING",
            "identifier": "COURSE 20-32231",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL CERTIFICATE IN COUNSELING ADDICTIVE DISORDERS AND MENTAL HEALTH",
            "identifier": "P852 NAADA",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH COUNSELOR",
            "identifier": "PHM 1453",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DIPLOMATE AMERICAN BOARD OF SEXOLOGY",
            "identifier": "2543",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Selys Yalexi Rivera-Reyes, B.A.
• Andrea Victoria Rivera-Sepulveda, M.D.
• Natalia Ivelisse Rivera-Smith, BA, MASJ, JD
• Michelle Y. Rivera-Vega, M.D.
• Nicole Rivera-Wynter, CRNA
• Aleyshka Lynn Rivera
• Alysa Joy Rivera, RBT
• Amalie A. Rivera
• Angelis Rivera
• Brooke Rivera, CRNA

• Mental Health Counselor in Orlando, FL
• Providers in Orlando, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; 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.