Provider Demographics
NPI:1558987156
Name:RASIC-REDZEMATOVIC, ENA
Entity Type:Individual
Prefix:
First Name:ENA
Middle Name:
Last Name:RASIC-REDZEMATOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9777 QUEENS BLVD PH
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3300
Mailing Address - Country:US
Mailing Address - Phone:718-896-9090
Mailing Address - Fax:718-830-0724
Practice Address - Street 1:9777 QUEENS BLVD PH
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3300
Practice Address - Country:US
Practice Address - Phone:718-896-9090
Practice Address - Fax:718-830-0724
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker