Provider Demographics
NPI:1073599379
Name:RISKIN, JEFFREY P (LISW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:RISKIN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638269
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:440-816-5790
Mailing Address - Fax:
Practice Address - Street 1:7265 OLD OAK BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3342
Practice Address - Country:US
Practice Address - Phone:440-816-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-0005344104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH537593000OtherMAGELLAN
OH716073000OtherMAGELLAN GROUP
OH98171OtherQUAL CHOICE
OHRISW28141Medicare PIN
OHQ20937Medicare UPIN
OHQ20937Medicare UPIN