Provider Demographics
NPI:1083602726
Name:RIDENTE, DENISE ENDRESS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ENDRESS
Last Name:RIDENTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:ENDRESS
Other - Last Name:RIDENTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:368 ESSEX AVE 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:908-380-3078
Mailing Address - Fax:
Practice Address - Street 1:368 ESSEX AVE 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:908-380-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC 043090001041C0700X
NJ8848364041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ190365OtherMENTAL HEALTH NETWORK
NJP1 035921OtherOXFORD
NJS51370Medicare ID - Type Unspecified