Provider Demographics
NPI:1205996188
Name:OLIVERIO, RITA M (PHD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:M
Last Name:OLIVERIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:OLIVERIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0732
Mailing Address - Country:US
Mailing Address - Phone:518-373-2208
Mailing Address - Fax:
Practice Address - Street 1:96 APPLETREE LN
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2104
Practice Address - Country:US
Practice Address - Phone:518-373-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012458103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY098793OtherMAGELLAN PIN
NMV0987OtherEMPIRE BLUE CROSS PIN
NY0005514236OtherAETNA PIN #
NY40188OtherCIGNABEHAVIORAL PIN NUMBE
NM6803835OtherGHI MAGELLAN PIN
NY112014OtherVALUEOPTIONS PIN
NY41200OtherMVP HEALTHCARE PIN
NY000470553003OtherBLUESHIELD NENY PIN
NY098793OtherMAGELLAN PIN