Provider Demographics
NPI:1881976942
Name:RIVKIN, MICHELLE (LPC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:RIVKIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2904
Mailing Address - Country:US
Mailing Address - Phone:973-943-8826
Mailing Address - Fax:201-530-5571
Practice Address - Street 1:483 CHURCHILL RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2904
Practice Address - Country:US
Practice Address - Phone:973-943-8826
Practice Address - Fax:201-530-5571
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00422200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional