Provider Demographics
NPI:1881751493
Name:RISS, LOIS ANN (LSCW)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ANN
Last Name:RISS
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MIDGELY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557
Mailing Address - Country:US
Mailing Address - Phone:516-295-5485
Mailing Address - Fax:
Practice Address - Street 1:6200 REV JOSEPH H MAY DRIVE BCH CHANNEL DRIVE
Practice Address - Street 2:JOSEPH P ADDABBO FAMILY HEALTH CENTER
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1409
Practice Address - Country:US
Practice Address - Phone:718-945-7150
Practice Address - Fax:718-634-4838
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRZ7823Medicare ID - Type Unspecified