Healthcare Provider Details

I. General information

NPI: 1720492481
Provider Name (Legal Business Name): DENISE RHRISSORRAKRAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 W 23RD ST 7TH FLOOR
NEW YORK NY
10010-4102
US

IV. Provider business mailing address

71 W 23RD ST 7TH FLOOR
NEW YORK NY
10010-4102
US

V. Phone/Fax

Practice location:
  • Phone: 212-576-4104
  • Fax: 212-576-4129
Mailing address:
  • Phone: 212-576-4104
  • Fax: 212-576-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092028
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: