Provider Demographics
NPI:1598037558
Name:RICCHETTI, CATHERINE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:RICCHETTI
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 1:101 SNAKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-5701
Mailing Address - Country:US
Mailing Address - Phone:518-892-0996
Mailing Address - Fax:518-674-4148
Practice Address - Street 1:101 SNAKE HILL RD
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-5701
Practice Address - Country:US
Practice Address - Phone:518-892-0996
Practice Address - Fax:518-674-4148
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051029104100000X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical