Healthcare Provider Details

I. General information

NPI: 1093041824
Provider Name (Legal Business Name): RISA SHARPE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax: 212-477-0521
Mailing address:
  • Phone: 212-982-3470
  • Fax: 212-477-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number079235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: