Provider Demographics
NPI:1770673964
Name:RIVERWAY COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:RIVERWAY COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUETENS
Authorized Official - Suffix:I
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-395-1560
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-0004
Mailing Address - Country:US
Mailing Address - Phone:781-395-1560
Mailing Address - Fax:781-391-5566
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3848
Practice Address - Country:US
Practice Address - Phone:781-395-1560
Practice Address - Fax:781-391-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9718681Medicaid
MARIP10176Medicare ID - Type Unspecified