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General NPI Number Information
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NPI Number | 1548590276
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Entity Type | Individual
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Provider Name | STACIE L RIVERS LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/31/2009
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 50 GREENHOUSE RD UNIT 50C
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City | BRIDGEPORT
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State | CT
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Zip | 06606-2141
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Country | US
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Telephone | 914-772-0361
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 110247
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City | TRUMBULL
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State | CT
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Zip | 06611-0247
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Country | US
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Telephone | 914-772-0361
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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