Provider Demographics
NPI:1215099858
Name:RIVEST, PAUL R (PHD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:RIVEST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66TH MDG SGOH
Mailing Address - Street 2:
Mailing Address - City:HANSCOM AFB
Mailing Address - State:MA
Mailing Address - Zip Code:01731
Mailing Address - Country:US
Mailing Address - Phone:781-377-4791
Mailing Address - Fax:781-377-4385
Practice Address - Street 1:66TH MDG SGOH
Practice Address - Street 2:
Practice Address - City:HANSCOM AFB
Practice Address - State:MA
Practice Address - Zip Code:01731
Practice Address - Country:US
Practice Address - Phone:781-377-4791
Practice Address - Fax:781-377-4385
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical