Provider Demographics
NPI:1053789180
Name:DETWEILER, RIVA HALEY
Entity type:Individual
Prefix:
First Name:RIVA
Middle Name:HALEY
Last Name:DETWEILER
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 1:15 BAY STATE AVE # 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4455
Practice Address - Country:US
Practice Address - Phone:781-329-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-05
Last Update Date:2015-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker