Basic Information
| Provider Information | |||||||||
| NPI: | 1063471415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVINUS | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | RN, CNS, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 PARK ST | ||||||||
| Address2: | |||||||||
| City: | ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012202100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136644343 | ||||||||
| FaxNumber: | 4136647320 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4138815427 | ||||||||
| FaxNumber: | 4134966836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 149071 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 0355801 | 05 | MA | MEDICAID | 1012386 | 05 | VT | MEDICAID |