Healthcare Provider Details

I. General information

NPI: 1518210202
Provider Name (Legal Business Name): PATRICIA RYKERT LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 STATION PLZ N STE 350A
MINEOLA NY
11501-3814
US

IV. Provider business mailing address

8 GULL CV
NORTHPORT NY
11768-1818
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2961
  • Fax: 516-663-8971
Mailing address:
  • Phone: 631-261-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number058888
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086572
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: