=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598037558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE RICCHETTI LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2012
-----------------------------------------------------
Last Update Date | 02/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 SNAKE HILL RD
-----------------------------------------------------
City | AVERILL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12018-5701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-892-0996
-----------------------------------------------------
Fax | 518-674-4148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 SNAKE HILL RD
-----------------------------------------------------
City | AVERILL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12018-5701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-892-0996
-----------------------------------------------------
Fax | 518-674-4148
-----------------------------------------------------
=====================================================
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 | R051029
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R051029
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | R051029
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------