Provider Demographics
NPI:1083867253
Name:RIVECCIO, EVAN JORDAN (SW CLINICAL)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:JORDAN
Last Name:RIVECCIO
Suffix:
Gender:M
Credentials:SW CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 WOODING RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2242
Mailing Address - Country:US
Mailing Address - Phone:203-294-0431
Mailing Address - Fax:
Practice Address - Street 1:501 LOMBARD ST.
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-787-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical