Healthcare Provider Details

I. General information

NPI: 1780094128
Provider Name (Legal Business Name): ASYA RIVINSON LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 VALLEY ST SUITE B1
MAPLEWOOD NJ
07040-2641
US

IV. Provider business mailing address

96 ELM ST
MILLBURN NJ
07041-2112
US

V. Phone/Fax

Practice location:
  • Phone: 800-870-6244
  • Fax:
Mailing address:
  • Phone: 800-870-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079083
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number44SC05647900
License Number StateNJ

VIII. Authorized Official

Name: MS. ASYA RIVINSON
Title or Position: BUSINESS OWNER
Credential: LCSW
Phone: 800-870-6244