Provider Demographics
NPI:1174892137
Name:RICCIO, CHRISTINE ANNE (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:RICCIO
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 1:11 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4601
Mailing Address - Country:US
Mailing Address - Phone:518-843-3180
Mailing Address - Fax:518-842-0012
Practice Address - Street 1:55 BRANDT PL
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-3200
Practice Address - Country:US
Practice Address - Phone:518-843-3716
Practice Address - Fax:518-843-6287
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO33616-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical