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General NPI Number Information
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NPI Number | 1194061325
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Entity Type | Organization
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Legal Business Name | ST. RAPHAEL MENTAL HEALTH COUNSELING, PC
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Dates
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Enumeration Date | 12/16/2012
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 10 E 16TH ST
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-2911
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Country | US
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Telephone | 631-923-2777
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Fax | 631-923-2777
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Provider Business Mailing Address
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Address Line | PO BOX 1276
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City | HUNTINGTON
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State | NY
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Zip | 11743-0657
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Country | US
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Telephone | 631-923-2777
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Fax | 631-923-2777
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALLISON RICCIARDI
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Credential | L.M.H.C.
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Telephone | 631-923-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002607-1
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License Number State | NY
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