Provider Demographics
NPI:1972574929
Name:RIVO, ANN DALE
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:DALE
Last Name:RIVO
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:DALE
Other - Last Name:RIVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1330 LINCOLN AVE
Mailing Address - Street 2:107
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2120
Mailing Address - Country:US
Mailing Address - Phone:415-459-1927
Mailing Address - Fax:
Practice Address - Street 1:1330 LINCOLN AVE
Practice Address - Street 2:107
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2120
Practice Address - Country:US
Practice Address - Phone:415-459-1927
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL83330Medicare ID - Type Unspecified