Provider Demographics
NPI:1558766204
Name:RIVKIN-HAAS, SOFIA CAROLINE (LMSW)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:CAROLINE
Last Name:RIVKIN-HAAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3112
Mailing Address - Country:US
Mailing Address - Phone:510-289-1115
Mailing Address - Fax:
Practice Address - Street 1:2236 27TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3112
Practice Address - Country:US
Practice Address - Phone:510-289-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092421-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker