Provider Demographics
NPI:1497509939
Name:RIVERSO, KALEIGH ANNE (RN)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:ANNE
Last Name:RIVERSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KALEIGH
Other - Middle Name:ANNE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:118 HINSDALE RD
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1629
Mailing Address - Country:US
Mailing Address - Phone:131-525-4782
Mailing Address - Fax:
Practice Address - Street 1:650 STATE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2839
Practice Address - Country:US
Practice Address - Phone:315-755-1251
Practice Address - Fax:315-291-6601
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY900965163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)