Healthcare Provider Details

I. General information

NPI: 1881529436
Provider Name (Legal Business Name): LAUREL RITTER-WISEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 QUEENS BLVD FL 2
FOREST HILLS NY
11375-3638
US

IV. Provider business mailing address

55 S 11TH ST APT 3C
BROOKLYN NY
11249-7042
US

V. Phone/Fax

Practice location:
  • Phone: 888-272-9355
  • Fax:
Mailing address:
  • Phone: 610-416-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131814
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: