Provider Demographics
NPI:1053354977
Name:TIVERS, RICK (LCSW)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:TIVERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HINMAN AVE
Mailing Address - Street 2:4 N
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3000
Mailing Address - Country:US
Mailing Address - Phone:847-492-1274
Mailing Address - Fax:
Practice Address - Street 1:525 HINMAN AVE
Practice Address - Street 2:4 N
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3000
Practice Address - Country:US
Practice Address - Phone:847-492-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490006061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical