Healthcare Provider Details

I. General information

NPI: 1265221501
Provider Name (Legal Business Name): JACQUELINE RIZZUTO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE LASHER LMSW

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ISLAND BLVD
BOHEMIA NY
11716-4923
US

IV. Provider business mailing address

30 ISLAND BLVD
BOHEMIA NY
11716-4923
US

V. Phone/Fax

Practice location:
  • Phone: 631-806-6499
  • Fax:
Mailing address:
  • Phone: 631-806-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number041344-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: