Provider Demographics
NPI:1336624410
Name:RIVERS, AMY LEAH
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEAH
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:LEAH
Other - Last Name:LAURILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5982 RHODES RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240
Mailing Address - Country:US
Mailing Address - Phone:330-673-1347
Mailing Address - Fax:330-678-3677
Practice Address - Street 1:2421 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3116
Practice Address - Country:US
Practice Address - Phone:330-452-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician