Provider Demographics
NPI:1558104653
Name:RIVARD, ALEXANDRIA CLAIRE
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:CLAIRE
Last Name:RIVARD
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 1:27 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6101
Mailing Address - Country:US
Mailing Address - Phone:860-841-4774
Mailing Address - Fax:
Practice Address - Street 1:27 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6101
Practice Address - Country:US
Practice Address - Phone:860-841-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst