Healthcare Provider Details

I. General information

NPI: 1104736263
Provider Name (Legal Business Name): HANNAH LACEY RIDDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 BROADWAY STE 2125
NEW YORK NY
10018-9228
US

IV. Provider business mailing address

212 5TH AVE APT 3L
BROOKLYN NY
11215-1299
US

V. Phone/Fax

Practice location:
  • Phone: 914-582-9592
  • Fax:
Mailing address:
  • Phone: 339-832-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: