Provider Demographics
NPI:1760536767
Name:RIVERS, LANEE SUSANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LANEE
Middle Name:SUSANN
Last Name:RIVERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307194
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803-7194
Mailing Address - Country:US
Mailing Address - Phone:340-715-2415
Mailing Address - Fax:
Practice Address - Street 1:9048 SUGAR ESTATE
Practice Address - Street 2:SCHNEIDER REGIONAL MEDICAL CENTER
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-776-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIVI-06-022-PSY103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI06-022-PSYOtherPSYCHOLOGIST