Provider Demographics
NPI:1558426403
Name:SHANEYFELT, RIVON
Entity Type:Individual
Prefix:MS
First Name:RIVON
Middle Name:
Last Name:SHANEYFELT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RIVON
Other - Middle Name:
Other - Last Name:SHANEYFELT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW;LCSW-C
Mailing Address - Street 1:10 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1806
Mailing Address - Country:US
Mailing Address - Phone:202-207-8214
Mailing Address - Fax:
Practice Address - Street 1:10 WEBB RD
Practice Address - Street 2:
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1806
Practice Address - Country:US
Practice Address - Phone:202-207-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172001041C0700X
DCLC500789311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical