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
Certification Date: 2021-07-21
Details
Name | Value | ||||||||||||
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NPI | 1902262959 | ||||||||||||
Enumeration Date | 2016-01-06 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
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: | ||||||||||||
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