Provider Demographics
NPI:1962416248
Name:DE RIDDER, NELLY F (PHD, LCSW-R)
Entity type:Individual
Prefix:DR
First Name:NELLY
Middle Name:F
Last Name:DE RIDDER
Suffix:
Gender:F
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156B HERITAGE HLS
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-1117
Mailing Address - Country:US
Mailing Address - Phone:914-420-8722
Mailing Address - Fax:
Practice Address - Street 1:52 NORTH BROADWAY
Practice Address - Street 2:RDC COUNSELING CENTER
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603
Practice Address - Country:US
Practice Address - Phone:914-798-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036473-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN54881Medicare ID - Type Unspecified