Provider Demographics
NPI:1104187004
Name:RIDGEWAY, YVETTE MICHELLE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:MICHELLE
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21321 NASHVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2333
Mailing Address - Country:US
Mailing Address - Phone:646-361-1363
Mailing Address - Fax:
Practice Address - Street 1:21321 NASHVILLE BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2333
Practice Address - Country:US
Practice Address - Phone:646-361-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174650103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst