Provider Demographics
NPI:1033222393
Name:RIVLIN, SHARON B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:B
Last Name:RIVLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ESPERANCE
Mailing Address - State:NY
Mailing Address - Zip Code:12066
Mailing Address - Country:US
Mailing Address - Phone:518-868-9734
Mailing Address - Fax:518-868-9734
Practice Address - Street 1:2707 CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ESPERANCE
Practice Address - State:NY
Practice Address - Zip Code:12066
Practice Address - Country:US
Practice Address - Phone:518-868-9734
Practice Address - Fax:518-868-9734
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02157311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY108609OtherMHN
NY131634OtherCOPHP VO
NYN3684OtherEMPIRE BC
NY0004J8060003OtherBLUE SHIELD
NY01803130Medicaid
NYIP289060OtherMAGELLAN
NY5806277OtherAETNA
NY61251OtherMVP
NY740210YOtherVALUE OPTION EMPIRE
NY740210YOtherVALUE OPTION EMPIRE