Individual
LANEY LEANNE RIVENBARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
345 GREENWOOD ST STE A, WORCESTER, MA 01607-1767
(508) 363-0200
Mailing address
19 WATER ST, HUDSON, MA 01749-2309
(617) 763-1476
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TJX981442947
BLUE CROSS, BLUE SHEILD
MA
Enumeration date
03/27/2019
Last updated
03/27/2019
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