Provider Demographics
NPI:1275759755
Name:RIVERS, BEVERLY A (LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:RIVERS
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 1:11514 ORLEANS LN
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1128
Mailing Address - Country:US
Mailing Address - Phone:914-309-5506
Mailing Address - Fax:
Practice Address - Street 1:11514 ORLEANS LN
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1128
Practice Address - Country:US
Practice Address - Phone:914-309-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0567111041C0700X
FLSW134001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02216360Medicaid
NYRO56711OtherLICENSED CLINICAL SOCIAL
NY11645OtherCASAC