Provider Demographics
NPI:1780044784
Name:KATZ, RIVI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RIVI
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RIVI
Other - Middle Name:
Other - Last Name:KANAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1485 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3626
Mailing Address - Country:US
Mailing Address - Phone:201-837-9090
Mailing Address - Fax:
Practice Address - Street 1:1485 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3626
Practice Address - Country:US
Practice Address - Phone:201-837-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056672001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1780044784Medicaid