Provider Demographics
NPI:1922108547
Name:LARIVIERE, ESA JEANETTE (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ESA
Middle Name:JEANETTE
Last Name:LARIVIERE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:ESA
Other - Middle Name:JEANETTE
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:509-363-2762
Practice Address - Street 1:107 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1510
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:509-363-2762
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000071281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA279493OtherMANAGED HEALTH CARE
WAAB34406Medicare ID - Type UnspecifiedMEDICARE PART B
WA279493OtherMANAGED HEALTH CARE