Provider Demographics
NPI:1295986008
Name:MCGOVERN, RIVKA (LCSW)
Entity type:Individual
Prefix:
First Name:RIVKA
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RIVKA
Other - Middle Name:
Other - Last Name:KORMAN, DOTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7219 N LITCHFIELD RD
Mailing Address - Street 2:56 MEDICAL GROUP
Mailing Address - City:LUKE AIR FORCE BASE
Mailing Address - State:AZ
Mailing Address - Zip Code:85309-1529
Mailing Address - Country:US
Mailing Address - Phone:623-856-7579
Mailing Address - Fax:623-856-4433
Practice Address - Street 1:7219 N LITCHFIELD ROAD
Practice Address - Street 2:56 MEDICAL GROUP
Practice Address - City:LUKE AFB
Practice Address - State:AZ
Practice Address - Zip Code:85309-1525
Practice Address - Country:US
Practice Address - Phone:623-856-7579
Practice Address - Fax:623-856-4433
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0809101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00072064Medicaid