Provider Demographics
NPI:1407454911
Name:TRYBENDIS, RETTA (LMSW)
Entity Type:Individual
Prefix:
First Name:RETTA
Middle Name:
Last Name:TRYBENDIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RETTA
Other - Middle Name:ANN
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:10 BEADART PL
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1218
Mailing Address - Country:US
Mailing Address - Phone:518-245-6272
Mailing Address - Fax:
Practice Address - Street 1:10 BEADART PL
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1218
Practice Address - Country:US
Practice Address - Phone:518-245-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110498104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker