Provider Demographics
NPI:1356865471
Name:RAWAL, RONAK SUDESH (LMHC)
Entity Type:Individual
Prefix:
First Name:RONAK
Middle Name:SUDESH
Last Name:RAWAL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:RONAK
Other - Middle Name:SUDESH
Other - Last Name:RAWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:92 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4108
Mailing Address - Country:US
Mailing Address - Phone:516-343-7731
Mailing Address - Fax:
Practice Address - Street 1:160 HOWELLS RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5320
Practice Address - Country:US
Practice Address - Phone:516-343-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health