Provider Demographics
NPI:1609954924
Name:RIVAS, NANCY EM (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:EM
Last Name:RIVAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N MILL ST STE L
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4860
Mailing Address - Country:US
Mailing Address - Phone:331-229-3123
Mailing Address - Fax:331-226-0780
Practice Address - Street 1:1805 N MILL ST STE L
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4860
Practice Address - Country:US
Practice Address - Phone:331-229-3123
Practice Address - Fax:331-226-0780
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical