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General NPI Number Information
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NPI Number | 1780094128
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Entity Type | Organization
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Legal Business Name | ASYA RIVINSON LCSW PC
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 697 VALLEY ST SUITE B1
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-2641
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Country | US
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Telephone | 800-870-6244
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Fax |
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Provider Business Mailing Address
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Address Line | 96 ELM ST
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City | MILLBURN
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State | NJ
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Zip | 07041-2112
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Country | US
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Telephone | 800-870-6244
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MS. ASYA RIVINSON
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Credential | LCSW
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Telephone | 800-870-6244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 44SC05647900
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License Number State | NJ
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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 | 079083
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License Number State | NY
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