Healthcare Provider Details

I. General information

NPI: 1154956886
Provider Name (Legal Business Name): RISING GROUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 MANIDA ST
BRONX NY
10474-6403
US

IV. Provider business mailing address

463 HAWTHORNE AVE
YONKERS NY
10705-3441
US

V. Phone/Fax

Practice location:
  • Phone: 914-991-4080
  • Fax:
Mailing address:
  • Phone: 914-375-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALAN MUCATEL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 914-375-8700