Provider Demographics
NPI:1063022069
Name:GARDNER, RIVA STAR (ASW)
Entity Type:Individual
Prefix:MS
First Name:RIVA
Middle Name:STAR
Last Name:GARDNER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SAN JOSE AVE APT D
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-7673
Mailing Address - Country:US
Mailing Address - Phone:949-636-2975
Mailing Address - Fax:
Practice Address - Street 1:2325 CLEMENT AVE STE A
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-7061
Practice Address - Country:US
Practice Address - Phone:510-629-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA925531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical