1033222393 NPI number — MS. SHARON B RIVLIN LCSW

Table of content: MS. SHARON B RIVLIN LCSW (NPI 1033222393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033222393 NPI number — MS. SHARON B RIVLIN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVLIN
Provider First Name:
SHARON
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1033222393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2707 CREEK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESPERANCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-868-9734
Provider Business Mailing Address Fax Number:
518-868-9734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2707 CREEK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESPERANCE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-868-9734
Provider Business Practice Location Address Fax Number:
518-868-9734
Provider Enumeration Date:
08/17/2006

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: 1041C0700X , with the licence number:  R0215731 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 108609 . This is a "MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 131634 . This is a "COPHP VO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N3684 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0004J8060003 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01803130 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: IP289060 . This is a "MAGELLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5806277 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 61251 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 740210Y . This is a "VALUE OPTION EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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