Healthcare Provider Details

I. General information

NPI: 1528615283
Provider Name (Legal Business Name): RIVA MIRIAM WEINSTOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 PROSPECT AVE E
CLEVELAND OH
44115-2704
US

IV. Provider business mailing address

13833 CEDAR RD APT 203
SOUTH EUCLID OH
44118-2358
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-4600
  • Fax:
Mailing address:
  • Phone: 216-246-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: