Provider Demographics
NPI:1134408131
Name:RIVERS, KIMBERLYN DARCELL (MED, MSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLYN
Middle Name:DARCELL
Last Name:RIVERS
Suffix:
Gender:F
Credentials:MED, MSW
Other - Prefix:MS
Other - First Name:KIMBERLYN
Other - Middle Name:DARCELL
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, MSW
Mailing Address - Street 1:1315 WINDRIM AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2710
Mailing Address - Country:US
Mailing Address - Phone:215-456-2721
Mailing Address - Fax:215-456-2713
Practice Address - Street 1:1315 WINDRIM AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2710
Practice Address - Country:US
Practice Address - Phone:215-456-2721
Practice Address - Fax:215-456-2713
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)