Provider Demographics
NPI:1629211370
Name:RIVKIN, IVY
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:RIVKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BRADFORD AVE
Mailing Address - Street 2:APT #2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2801
Mailing Address - Country:US
Mailing Address - Phone:518-265-3318
Mailing Address - Fax:
Practice Address - Street 1:41 MASON ST
Practice Address - Street 2:UNIT 4
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2260
Practice Address - Country:US
Practice Address - Phone:518-265-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health