Provider Demographics
NPI:1750452124
Name:RIORDAN, DOLORES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:
Last Name:RIORDAN
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 1:111 SMITHTOWN BYPASS
Mailing Address - Street 2:SUITE124
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2512
Mailing Address - Country:US
Mailing Address - Phone:631-366-3268
Mailing Address - Fax:631-366-3268
Practice Address - Street 1:111 SMITHTOWN BYPASS
Practice Address - Street 2:SUITE124
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2512
Practice Address - Country:US
Practice Address - Phone:631-366-3268
Practice Address - Fax:631-366-3268
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0373951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PIN #HIP25326OtherHIP (HAUPPAUGE)
NY1968161Medicaid
992864HPOtherMAGELLAN
PRIS#37454POtherHIP (HICKSVILLE)
037395A37OtherHEALTHFIRST HAUPP
68427OtherVALUE OPTIONS
27315DROtherVYTRA
192632HKOtherMAGELLAN
PIN#HIP25727OtherHIP (HICKSVILLE)
PRIS#12611POtherHIP (HAUPPAUGE)
103282SSPSOtherVYTRA
179421OtherMHN
037395B37OtherHEALTHFIRST HICKS
P1876124OtherOXFORD
68427OtherVALUE OPTIONS
NYN4M561Medicare ID - Type Unspecified