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General NPI Number Information
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NPI Number | 1790907574
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Entity Type | Individual
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Provider Name | THOMAS J RIVIELLO LMHC
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 600 JOHNSON AVENUE
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City | BOHEMIA
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State | NY
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Zip | 11716
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Country | US
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Telephone | 516-448-8748
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Fax |
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Provider Business Mailing Address
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Address Line | 16 NANCY DR
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City | SAYVILLE
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State | NY
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Zip | 11782-2915
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Country | US
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Telephone | 516-448-8748
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002062
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License Number State | NY
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