MEDICARE: MRS. SALLYANN RICCIARDI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R0469241	NY

General Provider Information

NPI Number	:	1306985973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLYANN RICCIARDI LCSW

Provider Business Mailing Address
First Line	:	87 VALLEY AVE
Second Line	:
City	:	LOCUST VALLEY
State	:	NY
Zip	:	11560-2013
Country	:	US
Telephone Number	:	516-674-8588
Fax Number	:	516-671-2580

Provider Business Practice Location Address
First Line	:	87 VALLEY AVE
Second Line	:
City	:	LOCUST VALLEY
State	:	NY
Zip	:	11560-2013
Country	:	US
Telephone Number	:	516-674-8588
Fax Number	:	516-671-2580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	09/16/2021

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