Individual
CARRIEBETH RIVAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC, CASAC
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
004603
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02664359
—
NY
01
—
051104000053
FIDELIS
NY
Enumeration date
10/29/2010
Last updated
09/25/2013
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