Provider Demographics
NPI:1922596543
Name:RIDGE PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:RIDGE PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SANTIS-MONIACI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-921-0704
Mailing Address - Street 1:446 74TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2602
Mailing Address - Country:US
Mailing Address - Phone:917-921-0704
Mailing Address - Fax:
Practice Address - Street 1:446 74TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2602
Practice Address - Country:US
Practice Address - Phone:917-921-0704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty