Healthcare Provider Details

I. General information

NPI: 1922565886
Provider Name (Legal Business Name): ABIGAIL RIVAS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 JACKSON ST
EAST ISLIP NY
11730-1121
US

IV. Provider business mailing address

46 JACKSON ST
EAST ISLIP NY
11730-1121
US

V. Phone/Fax

Practice location:
  • Phone: 631-707-1250
  • Fax:
Mailing address:
  • Phone: 631-707-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1922565886
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: