Provider Demographics
NPI:1982769352
Name:RISEMAN, JACQUELINE SARAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SARAH
Last Name:RISEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:SARAH
Other - Last Name:RISEMAN-DETSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:122 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1134
Mailing Address - Country:US
Mailing Address - Phone:914-967-6531
Mailing Address - Fax:914-967-6531
Practice Address - Street 1:122 STERLING RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1134
Practice Address - Country:US
Practice Address - Phone:914-967-6531
Practice Address - Fax:914-967-6531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health