1750452124 NPI number — MS. DOLORES RIORDAN LCSW

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750452124 NPI number — MS. DOLORES RIORDAN LCSW

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RIORDAN

Provider First Name:

DOLORES

Provider Middle Name:

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

LCSW

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1750452124

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

111 SMITHTOWN BYPASS

Provider Second Line Business Mailing Address:

SUITE124

Provider Business Mailing Address City Name:

HAUPPAUGE

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11788-2512

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

631-366-3268

Provider Business Mailing Address Fax Number:

631-366-3268

Provider First Line Business Practice Location Address:

111 SMITHTOWN BYPASS

Provider Second Line Business Practice Location Address:

SUITE124

Provider Business Practice Location Address City Name:

HAUPPAUGE

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11788-2512

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

631-366-3268

Provider Business Practice Location Address Fax Number:

631-366-3268

Provider Enumeration Date:

11/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  R037395 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: PIN #HIP25326 . This is a "HIP (HAUPPAUGE)" identifier . This identifiers is of the category "OTHER".
• Identifier: 1968161 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 992864HP . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: PRIS#37454P . This is a "HIP (HICKSVILLE)" identifier . This identifiers is of the category "OTHER".
• Identifier: 037395A37 . This is a "HEALTHFIRST HAUPP" identifier . This identifiers is of the category "OTHER".
• Identifier: 68427 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
• Identifier: 27315DR . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
• Identifier: 192632HK . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: PIN#HIP25727 . This is a "HIP (HICKSVILLE)" identifier . This identifiers is of the category "OTHER".
• Identifier: PRIS#12611P . This is a "HIP (HAUPPAUGE)" identifier . This identifiers is of the category "OTHER".
• Identifier: 103282SSPS . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
• Identifier: 179421 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
• Identifier: 037395B37 . This is a "HEALTHFIRST HICKS" identifier . This identifiers is of the category "OTHER".
• Identifier: P1876124 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".