MEDICARE: DR. PATRICK DAVID RIVARD PH.D.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6301015252	MI
2	103T00000X	Psychologist	6301015252	MI
3	103TB0200X	Cognitive & Behavioral Psychologist	6301015252	MI
4	103TC0700X	Clinical Psychologist	6301015252	MI
5	103TC2200X	Clinical Child & Adolescent Psychologist	6301015252	MI
6	103TM1800X	Intellectual & Developmental Disabilities Psychologist	6301015252	MI
7	103TP2701X	Group Psychotherapy Psychologist	6301015252	MI
8	103TS0200X	School Psychologist	179302	MI
9	104100000X	Social Worker	6801013804	MI
10	1041C0700X	Clinical Social Worker	6801013804	MI

General Provider Information

NPI Number	:	1205271822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK DAVID RIVARD PH.D.

Provider Business Mailing Address
First Line	:	8530 CLINTON RIVER RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1627
Country	:	US
Telephone Number	:	586-739-3680
Fax Number	:

Provider Business Practice Location Address
First Line	:	8530 CLINTON RIVER RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1627
Country	:	US
Telephone Number	:	586-739-3680
Fax Number	:

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

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	05/09/2013

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