MEDICARE: MS. ASYA RIVINSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	079083-1	NY
2	1041C0700X	Clinical Social Worker	44SC05647900	NJ

General Provider Information

NPI Number	:	1093974339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASYA RIVINSON LCSW

Provider Business Mailing Address
First Line	:	96 ELM ST
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-2112
Country	:	US
Telephone Number	:	800-870-6244
Fax Number	:

Provider Business Practice Location Address
First Line	:	697 VALLEY ST
Second Line	:	SUITE B1
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2641
Country	:	US
Telephone Number	:	800-870-6244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	03/18/2017

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