Active NPI
Anita G. Risener, LCSW-R
- Clinical Social Worker
- Medford, NY
National Provider Identifier
1225106792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R025226
- Practice address
- 3293 RT 112
BLG 8 Suite 8
Medford, NY 11763-1432 - Phone
- (631) 331-8595
- Fax
- (631) 331-8595
- NPI assigned
- Dec 1, 2006
- Last updated
- Oct 5, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R025226 | NY | Primary |
Addresses
Primary practice location
3293 RT 112
BLG 8 Suite 8
Medford, NY 11763-1432
Mailing address
3 Merrimac CT
Coram, NY 11727-1632
Phone (631) 331-8595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120416 | Other | NY | VYTRA PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R025226 | NY | MD | Clinical Social Worker |
| 025226 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Butterfly Clinical Inc. | Clinical | Past | Accepting new patients |
| Joseph M. Gagliano, LCSW, P.C. | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Avatar Counseling Innovations
- Clinical Social Worker
- Port Jefferson, NY
- NPI 1750682084
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475625600000",
"number": "1225106792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 MERRIMAC CT",
"city": "CORAM",
"state": "NY",
"postal_code": "117271632",
"telephone_number": "631-331-8595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3293 RT 112",
"address_2": "BLG 8 SUITE 8",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117631432",
"telephone_number": "631-331-8595",
"fax_number": "631-331-8595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RISENER",
"first_name": "ANITA",
"middle_name": "G.",
"credential": "LCSW-R",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2016-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R025226",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VYTRA PROVIDER #",
"identifier": "120416",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.