Provider Demographics
NPI:1063471415
Name:RIVINUS, ROBIN E (RN, CNS, NP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:RIVINUS
Suffix:
Gender:F
Credentials:RN, CNS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-2100
Mailing Address - Country:US
Mailing Address - Phone:413-664-4343
Mailing Address - Fax:413-664-7320
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-881-5427
Practice Address - Fax:413-496-6836
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149071363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0355801Medicaid
VT1012386Medicaid
VT1012386Medicaid
R34488Medicare UPIN