Provider Demographics
NPI:1992393367
Name:RIVENSON-SCHULMAN, PHYLLIS LINDA
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:LINDA
Last Name:RIVENSON-SCHULMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W DEVONIA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1029
Mailing Address - Country:US
Mailing Address - Phone:914-803-3554
Mailing Address - Fax:
Practice Address - Street 1:66 W DEVONIA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1029
Practice Address - Country:US
Practice Address - Phone:914-803-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225A00000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty