Provider Demographics
NPI:1932494044
Name:RIVERS, SHEILA M (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:M
Last Name:RIVERS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 PAOLI PIKE
Mailing Address - Street 2:MALVERN, PA
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2960
Mailing Address - Country:US
Mailing Address - Phone:215-962-4382
Mailing Address - Fax:484-320-8307
Practice Address - Street 1:292 PAOLI PIKE
Practice Address - Street 2:MALVERN, PA
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2960
Practice Address - Country:US
Practice Address - Phone:215-962-4382
Practice Address - Fax:484-320-8307
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-07-3911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst