Provider Demographics
NPI:1275829350
Name:RIDGE, JULIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:RIDGE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 43RD ST
Mailing Address - Street 2:SUITE 6-S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6302
Mailing Address - Country:US
Mailing Address - Phone:917-214-2981
Mailing Address - Fax:
Practice Address - Street 1:400 W 43RD ST
Practice Address - Street 2:SUITE 6-S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6302
Practice Address - Country:US
Practice Address - Phone:917-214-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0503131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical