Provider Demographics
NPI:1740505999
Name:RESTIVO, MILDRED ROLDAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:ROLDAN
Last Name:RESTIVO
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 1:426 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2040
Mailing Address - Country:US
Mailing Address - Phone:518-374-3403
Mailing Address - Fax:518-374-3482
Practice Address - Street 1:426 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2040
Practice Address - Country:US
Practice Address - Phone:518-374-3403
Practice Address - Fax:518-374-3482
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04175911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical