Provider Demographics
NPI:1902209000
Name:RISTESKA, DANA (MSW)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:RISTESKA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07844-9800
Mailing Address - Country:US
Mailing Address - Phone:908-674-5407
Mailing Address - Fax:
Practice Address - Street 1:101 MOUNTAIN CT STE 101B
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2300
Practice Address - Country:US
Practice Address - Phone:908-674-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05787500104100000X
NJ44SC056453001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1174050256OtherNPI FOR LLC