Provider Demographics
NPI:1780094128
Name:ASYA RIVINSON LCSW PC
Entity type:Organization
Organization Name:ASYA RIVINSON LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:800-870-6244
Mailing Address - Street 1:96 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-2112
Mailing Address - Country:US
Mailing Address - Phone:800-870-6244
Mailing Address - Fax:
Practice Address - Street 1:697 VALLEY ST
Practice Address - Street 2:SUITE B1
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2641
Practice Address - Country:US
Practice Address - Phone:800-870-6244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05647900261Q00000X
NY0790831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY079083OtherLCSW
NJ44SC05647900OtherLCSW