Provider Demographics
NPI:1164886347
Name:ALTIMIRAS RIERA, BERNAT (BCBA, LMHC, MS)
Entity type:Individual
Prefix:
First Name:BERNAT
Middle Name:
Last Name:ALTIMIRAS RIERA
Suffix:
Gender:M
Credentials:BCBA, LMHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9521 DELANEY CREEK BLVD APT 221
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5186
Mailing Address - Country:US
Mailing Address - Phone:786-436-4244
Mailing Address - Fax:
Practice Address - Street 1:4236 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5241
Practice Address - Country:US
Practice Address - Phone:813-557-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL1-18-33741103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health