=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346300472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RISA KATZ LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 06/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 BROAD HOLLOW ROAD
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-312-2891
-----------------------------------------------------
Fax | 631-414-7273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 BROAD HOLLOW ROAD
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-312-2891
-----------------------------------------------------
Fax | 631-414-7273
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 0570631
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 0570631
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------