Provider Demographics
NPI:1679606784
Name:RICCIARDI GOLDEN, LORRAINE (NPP,RN)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:RICCIARDI GOLDEN
Suffix:
Gender:F
Credentials:NPP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784
Mailing Address - Country:US
Mailing Address - Phone:631-880-3947
Mailing Address - Fax:
Practice Address - Street 1:99 HOLLYWOOD DR.
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-366-5800
Practice Address - Fax:631-366-2935
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401026363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health