Provider Demographics
NPI:1356758791
Name:RIVELLO, SHELLY D (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:D
Last Name:RIVELLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WARM SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2350
Mailing Address - Country:US
Mailing Address - Phone:814-643-8785
Mailing Address - Fax:814-643-8360
Practice Address - Street 1:1225 WARM SPRINGS AVE
Practice Address - Street 2:JC BLAIR MEMORIAL HOSPITAL - BEHAVIORAL HEALTH SERVICES
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2350
Practice Address - Country:US
Practice Address - Phone:814-643-8785
Practice Address - Fax:814-643-8360
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0167081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical