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General NPI Number Information
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NPI Number | 1174853691
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Entity Type | Individual
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Provider Name | ANNE RIVERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 12 ROOSEVELT AVE SUITE 203
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City | MYSTIC
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State | CT
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Zip | 06355-2809
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Country | US
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Telephone | 860-536-4383
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Fax | 860-536-2873
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Provider Business Mailing Address
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Address Line | 12 ROOSEVELT AVE
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City | MYSTIC
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State | CT
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Zip | 06355-2809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 00664
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | RO39293-1
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License Number State | NY
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