Healthcare Provider Details

I. General information

NPI: 1114590163
Provider Name (Legal Business Name): RISING POTENTIAL COUNSELING LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5649 ROME NEW LONDON RD
ROME NY
13440-8336
US

IV. Provider business mailing address

5649 ROME NEW LONDON RD
ROME NY
13440-8336
US

V. Phone/Fax

Practice location:
  • Phone: 315-520-0859
  • Fax: 315-281-8213
Mailing address:
  • Phone: 315-520-0859
  • Fax: 315-281-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS DANIEL RAMIREZ
Title or Position: DOCTOR / CEO
Credential: PH.D., DSW, LCSW
Phone: 315-520-0859