Provider Demographics
NPI:1780380568
Name:RIVAGE, ROSE M
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:RIVAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 FERNLEA DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5467
Mailing Address - Country:US
Mailing Address - Phone:561-360-7034
Mailing Address - Fax:
Practice Address - Street 1:312 S OLD DIXIE HWY STE 202
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7489
Practice Address - Country:US
Practice Address - Phone:561-360-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-208373106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician