Provider Demographics
NPI:1912142431
Name:RINKO, DOUGLAS GREGORY (LCSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:GREGORY
Last Name:RINKO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2703
Mailing Address - Country:US
Mailing Address - Phone:315-472-4471
Mailing Address - Fax:315-472-1759
Practice Address - Street 1:1045 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2703
Practice Address - Country:US
Practice Address - Phone:315-472-4471
Practice Address - Fax:315-472-1759
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-1129675Medicaid