Provider Demographics
NPI:1861617961
Name:BUDOFSKY ROSS, RISA FERN (LCSW)
Entity type:Individual
Prefix:MS
First Name:RISA
Middle Name:FERN
Last Name:BUDOFSKY ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 OLD COUNTRY ROAD
Mailing Address - Street 2:STE 6
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-822-9143
Mailing Address - Fax:
Practice Address - Street 1:1171 OLD COUNTRY ROAD
Practice Address - Street 2:STE 6
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-822-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02592911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical