Individual
ANITA G. RISENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-R
Contact information
Practice address
3293 RT 112, BLG 8 SUITE 8, MEDFORD, NY 11763-1432
(631) 331-8595
(631) 331-8595
Mailing address
3 MERRIMAC CT, CORAM, NY 11727-1632
(631) 331-8595
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R025226
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120416
VYTRA PROVIDER #
NY
Enumeration date
12/01/2006
Last updated
10/05/2016
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