Provider Demographics
NPI:1265120679
Name:TABACOFF, RISA
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:TABACOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1819
Mailing Address - Country:US
Mailing Address - Phone:914-441-9505
Mailing Address - Fax:914-666-7687
Practice Address - Street 1:83 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-1819
Practice Address - Country:US
Practice Address - Phone:914-441-9505
Practice Address - Fax:914-666-7687
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016728103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist