Healthcare Provider Details

I. General information

NPI: 1992978670
Provider Name (Legal Business Name): ELAINE MARIE RIVAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE
BATH NY
14810-0810
US

IV. Provider business mailing address

303 E. HIGH STREET APT 301
PAINTED POST NY
14870
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4000
  • Fax: 607-664-4320
Mailing address:
  • Phone: 347-331-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: