Provider Demographics
NPI:1952851164
Name:SALLYANN RICCIARDI, LCSW-R,PC
Entity Type:Organization
Organization Name:SALLYANN RICCIARDI, LCSW-R,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-674-8588
Mailing Address - Street 1:27 THE PLAZA, SUITE B
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560
Mailing Address - Country:US
Mailing Address - Phone:516-674-8588
Mailing Address - Fax:516-671-2580
Practice Address - Street 1:27 THE PLAZA, SUITE B
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560
Practice Address - Country:US
Practice Address - Phone:516-674-8588
Practice Address - Fax:516-671-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNPI1306985973OtherMEDICARE
NYNT1401OtherMEDICARE