Provider Demographics
NPI:1003970708
Name:RISKIN, SUSAN R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:RISKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 HUNTINGTON LANE
Mailing Address - Street 2:#207
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2504
Mailing Address - Country:US
Mailing Address - Phone:561-865-5415
Mailing Address - Fax:
Practice Address - Street 1:21300 COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2175
Practice Address - Country:US
Practice Address - Phone:561-852-3333
Practice Address - Fax:561-852-3332
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0662721041C0700X
FLSW88431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical