Healthcare Provider Details

I. General information

NPI: 1205271822
Provider Name (Legal Business Name): PATRICK DAVID RIVARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 CLINTON RIVER RD
STERLING HEIGHTS MI
48314-1627
US

IV. Provider business mailing address

8530 CLINTON RIVER RD
STERLING HEIGHTS MI
48314-1627
US

V. Phone/Fax

Practice location:
  • Phone: 586-739-3680
  • Fax:
Mailing address:
  • Phone: 586-739-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6301015252
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015252
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301015252
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301015252
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301015252
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6301015252
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6301015252
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number179302
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801013804
License Number StateMI
# 10
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801013804
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: