Provider Demographics
NPI:1427290451
Name:RIFKIN-MAMARADLO, MICHELLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:RIFKIN-MAMARADLO
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 1:14 PRINCESS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2656
Mailing Address - Country:US
Mailing Address - Phone:718-816-0849
Mailing Address - Fax:
Practice Address - Street 1:14 PRINCESS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2656
Practice Address - Country:US
Practice Address - Phone:718-816-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker