Provider Demographics
NPI:1033608146
Name:CRIVERA, ROSE (SOCIAL WORKER LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:CRIVERA
Suffix:
Gender:F
Credentials:SOCIAL WORKER LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 RENSSELAER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2724
Mailing Address - Country:US
Mailing Address - Phone:646-220-3090
Mailing Address - Fax:
Practice Address - Street 1:518 RENSSELAER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2724
Practice Address - Country:US
Practice Address - Phone:646-220-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0578221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical