1588939102 NPI number — MS. RIVA XYLINA BENNETT LMHC, BCBA

Table of content: MS. RIVA XYLINA BENNETT LMHC, BCBA (NPI 1588939102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588939102 NPI number — MS. RIVA XYLINA BENNETT LMHC, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
RIVA
Provider Middle Name:
XYLINA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588939102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1109 EDELWEISS ST E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHIGH ACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33974-0434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-368-3154
Provider Business Mailing Address Fax Number:
239-368-3154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1109 EDELWEISS ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33974-0434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-322-6894
Provider Business Practice Location Address Fax Number:
239-368-3154
Provider Enumeration Date:
03/14/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH 8627 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-08-4732 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TS0200X , with the licence number: 1001170 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TS0200X , with the licence number: 00357584 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: SW 47601 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000531000 . This is a "MEDICAID DD WAIVER PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000648800 . This is a "MEDICAID DD WAIVER PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".