Provider Demographics
NPI:1942240841
Name:RIVAMONTE, VICTORIA CARMEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:CARMEN
Last Name:RIVAMONTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E 48TH ST
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1749
Mailing Address - Country:US
Mailing Address - Phone:212-576-1149
Mailing Address - Fax:212-576-1149
Practice Address - Street 1:321 E 48TH ST
Practice Address - Street 2:SUITE 1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1749
Practice Address - Country:US
Practice Address - Phone:212-576-1149
Practice Address - Fax:212-576-1149
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009229-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV30641Medicare ID - Type Unspecified