MEDICARE: DENISE MARY RIVET 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	SW4942	FL

General Provider Information

NPI Number	:	1164426557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MARY RIVET LCSW

Provider Business Mailing Address
First Line	:	105 S RIVERSIDE DR
Second Line	:	STE 100
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4321
Country	:	US
Telephone Number	:	321-733-2299
Fax Number	:	321-733-7515

Provider Business Practice Location Address
First Line	:	105 S RIVERSIDE DR
Second Line	:	STE 100
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4321
Country	:	US
Telephone Number	:	321-733-2299
Fax Number	:	321-733-7515

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	02/22/2010

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