Provider Demographics
NPI:1972536753
Name:RZETELNY, HARRIET (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HARRIET
Middle Name:
Last Name:RZETELNY
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 1:59 MAIN ST
Mailing Address - Street 2:APT. 44-2
Mailing Address - City:DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02638-1938
Mailing Address - Country:US
Mailing Address - Phone:508-385-2532
Mailing Address - Fax:508-385-2241
Practice Address - Street 1:156 5TH AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7002
Practice Address - Country:US
Practice Address - Phone:212-647-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWR0185451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN49121Medicare ID - Type Unspecified