Provider Demographics
NPI:1487923348
Name:SMITH, RIKI (CASAC-T, FAMILY DEV)
Entity type:Individual
Prefix:MS
First Name:RIKI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CASAC-T, FAMILY DEV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2525
Mailing Address - Country:US
Mailing Address - Phone:718-981-4382
Mailing Address - Fax:718-981-2054
Practice Address - Street 1:285 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2525
Practice Address - Country:US
Practice Address - Phone:718-981-4382
Practice Address - Fax:718-981-2054
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)