Healthcare Provider Details

I. General information

NPI: 1144108713
Provider Name (Legal Business Name): MADELINE LEE RIVER PSY.D
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ELM ST
STOCKBRIDGE MA
01262-7721
US

IV. Provider business mailing address

6 MAPLEWOOD AVE APT 25
PITTSFIELD MA
01201-4732
US

V. Phone/Fax

Practice location:
  • Phone: 413-693-2969
  • Fax:
Mailing address:
  • Phone: 210-912-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY900370
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY10000949
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: