Healthcare Provider Details

I. General information

NPI: 1588473912
Provider Name (Legal Business Name): SHAYNE RIVARD MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 TECHNOLOGY WAY
WEST GREENWICH RI
02817-1713
US

IV. Provider business mailing address

5 MCAVOY ST
PROVIDENCE RI
02903-1416
US

V. Phone/Fax

Practice location:
  • Phone: 401-474-0062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76755
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: