Provider Demographics
NPI:1346300472
Name:KATZ, RISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RISA
Middle Name:
Last Name:KATZ
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 1:555 BROAD HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5001
Mailing Address - Country:US
Mailing Address - Phone:516-312-2891
Mailing Address - Fax:631-414-7273
Practice Address - Street 1:555 BROAD HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:516-312-2891
Practice Address - Fax:631-414-7273
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0570631104100000X
NY0570631104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02456444Medicaid
P66785Medicare UPIN
NY02456444Medicaid