Provider Demographics
NPI:1679706535
Name:RIVKIN, ROSALYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:
Last Name:RIVKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 WOODMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1232
Mailing Address - Country:US
Mailing Address - Phone:510-526-2118
Mailing Address - Fax:206-237-5439
Practice Address - Street 1:566 WOODMONT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1232
Practice Address - Country:US
Practice Address - Phone:510-526-2118
Practice Address - Fax:206-237-5439
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS92711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical