Provider Demographics
NPI:1437429347
Name:RYAN, RAYME RIVET (LCSW)
Entity Type:Individual
Prefix:
First Name:RAYME
Middle Name:RIVET
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RAYME
Other - Middle Name:ANN
Other - Last Name:RIVET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1401 LITTLE ELM TRL UNIT 304
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2876
Mailing Address - Country:US
Mailing Address - Phone:210-410-7158
Mailing Address - Fax:
Practice Address - Street 1:1401 LITTLE ELM TRL UNIT 304
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2876
Practice Address - Country:US
Practice Address - Phone:210-410-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301358301Medicaid
TXTXB149525Medicare PIN