Provider Demographics
NPI:1386883189
Name:RIESENBERGER, JOAN E (LCSW-R)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:RIESENBERGER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PENBROOKE DR
Mailing Address - Street 2:BUILDING 2, SUITE K
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2041
Mailing Address - Country:US
Mailing Address - Phone:585-377-6470
Mailing Address - Fax:
Practice Address - Street 1:401 PENBROOKE DR
Practice Address - Street 2:BUILDING 2, SUITE K
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2041
Practice Address - Country:US
Practice Address - Phone:585-377-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR070540-11041C0700X
NY000502-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist