Provider Demographics
NPI:1124765813
Name:DESPRADEL, RICARDO YGNACIO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:YGNACIO
Last Name:DESPRADEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W 39TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1217
Mailing Address - Country:US
Mailing Address - Phone:347-740-2421
Mailing Address - Fax:
Practice Address - Street 1:61 GREENPOINT AVE. 6TH FLOOR
Practice Address - Street 2:#696
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222
Practice Address - Country:US
Practice Address - Phone:347-696-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health