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General NPI Number Information
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NPI Number | 1225106792
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Entity Type | Individual
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Provider Name | ANITA G. RISENER LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 3293 RT 112 BLG 8 SUITE 8
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City | MEDFORD
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State | NY
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Zip | 11763-1432
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Country | US
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Telephone | 631-331-8595
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Fax | 631-331-8595
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Provider Business Mailing Address
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Address Line | 3 MERRIMAC CT
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City | CORAM
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State | NY
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Zip | 11727-1632
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Country | US
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Telephone | 631-331-8595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R025226
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License Number State | NY
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