Healthcare Provider Details

I. General information

NPI: 1104472026
Provider Name (Legal Business Name): RIVKA NACHUM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 LEE ST
PERTH AMBOY NJ
08861-3053
US

IV. Provider business mailing address

2116 COLEMAN ST
BROOKLYN NY
11234-5036
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-1666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110814
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06621400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06469100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: