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General NPI Number Information
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NPI Number | 1720567506
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Entity Type | Individual
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Provider Name | SYDNY VANESSA RIVERS TLLP
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Gender | Female
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Dates
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Enumeration Date | 08/12/2018
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 315 N CENTER ST
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City | NORTHVILLE
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State | MI
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Zip | 48167-1277
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Country | US
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Telephone | 313-656-4052
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Fax |
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Provider Business Mailing Address
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Address Line | 3941 E NEVADA ST
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City | DETROIT
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State | MI
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Zip | 48234-1840
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362009331
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License Number State | MI
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