Healthcare Provider Details

I. General information

NPI: 1962416248
Provider Name (Legal Business Name): NELLY F DE RIDDER PHD, LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 NORTH BROADWAY RDC COUNSELING CENTER
WHITE PLAINS NY
10603
US

IV. Provider business mailing address

156B HERITAGE HLS
SOMERS NY
10589-1117
US

V. Phone/Fax

Practice location:
  • Phone: 914-798-1107
  • Fax:
Mailing address:
  • Phone: 914-420-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR036473-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: