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Provider Information for 1902262959


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LEANN RIDULFO LCSW


Sex: Female

NPI: 1902262959
Last Updated: 2021-07-21
Certification Date: 2021-07-21

Details

NameValue
NPI1902262959
Enumeration Date2016-01-06
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 475 E MAIN ST STE 101
EAST PATCHOGUE, NY 11772-3121
United States

Phone: 631-363-2001 | Fax:
 
Primary Practice Address 1448 FIFTH AVENUE
BAYSHORE, NY 11706
United States

Phone: 631-309-6837 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 171M00000X - Case Manager/Care Coordinator NY096791-1
Yes 1041C0700X - Social Worker - Clinical