Provider Demographics
NPI:1508295635
Name:RIVAS, AMELIA (MS, LLP)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:RIVAS
Suffix:
Gender:
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 BIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-7891
Mailing Address - Country:US
Mailing Address - Phone:248-444-7378
Mailing Address - Fax:
Practice Address - Street 1:2514 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-7891
Practice Address - Country:US
Practice Address - Phone:248-444-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical