Healthcare Provider Details

I. General information

NPI: 1073566923
Provider Name (Legal Business Name): RITA KARDACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PASTURE LN ROSLYN HEIGHTS
ROSLYN HEIGHTS NY
11577-2609
US

IV. Provider business mailing address

PO BOX 151 ROSLYN HEIGHTS
ROSLYN HEIGHTS NY
11577-0151
US

V. Phone/Fax

Practice location:
  • Phone: 516-626-5390
  • Fax: 516-626-6246
Mailing address:
  • Phone: 516-626-5390
  • Fax: 516-626-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR052735
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: