Provider Demographics
NPI:1578569422
Name:RIVERSIDE PSYCHOTHERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:RIVERSIDE PSYCHOTHERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAACK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPA
Authorized Official - Phone:985-718-9110
Mailing Address - Street 1:79 PARK LN
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-7721
Mailing Address - Country:US
Mailing Address - Phone:985-718-9110
Mailing Address - Fax:
Practice Address - Street 1:79 PARK LN
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-7721
Practice Address - Country:US
Practice Address - Phone:985-718-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA570103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========0OtherBCBS LA
LA=========0OtherBCBS LA
LADE8346Medicare PIN
LA5CF32Medicare PIN