Provider Demographics
NPI:1386288165
Name:RIVLIN, CHRISTINE LEE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEE
Last Name:RIVLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W OLYMPIC BLVD STE 627
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4135
Mailing Address - Country:US
Mailing Address - Phone:925-250-9236
Mailing Address - Fax:
Practice Address - Street 1:714 W OLYMPIC BLVD STE 627
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4135
Practice Address - Country:US
Practice Address - Phone:925-250-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty