Provider Demographics
NPI:1346508595
Name:RIVERS, LYNETRIC ANNE (MA, LSW, CDCA)
Entity Type:Individual
Prefix:MRS
First Name:LYNETRIC
Middle Name:ANNE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:MA, LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 TURNEY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-337-9664
Mailing Address - Fax:
Practice Address - Street 1:5706 TURNEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3971
Practice Address - Country:US
Practice Address - Phone:216-337-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340720558104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker