Provider Demographics
NPI:1124743216
Name:RIDLEY, KATHERINE GRACE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GRACE
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MANNING BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1426
Mailing Address - Country:US
Mailing Address - Phone:631-578-6336
Mailing Address - Fax:
Practice Address - Street 1:840 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-1054
Practice Address - Country:US
Practice Address - Phone:631-578-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117170104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker