Provider Demographics
NPI:1417593732
Name:KRIETE, RICARDO HAROLD
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:HAROLD
Last Name:KRIETE
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 1:4610 CENTER BLVD APT 2314
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5887
Mailing Address - Country:US
Mailing Address - Phone:401-835-8588
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVENUE
Practice Address - Street 2:12A FL. SUITE 9
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-220-0856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP10416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243825Medicaid