Active NPI
Andrea Jane Riskin, PSY.D.
- Clinical Psychologist
- Ridgewood, NJ
National Provider Identifier
1992029995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35S100504300
- Practice address
- 1 Prospect St
Ridgewood, NJ 07450-4404 - Phone
- (201) 447-2242
- NPI assigned
- Mar 18, 2010
- Sex
- Female
- Sole proprietor
- No
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 Psychologist | 103TC0700X | 35S100504300 | NJ | Primary |
Addresses
Primary practice location
1 Prospect St
Ridgewood, NJ 07450-4404
Mailing address
38-43 Dauria Dr
Fair Lawn, NJ 07410-5104
Phone (201) 796-6188
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35S100504300 | NJ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514851200000",
"number": "1992029995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38-43 DAURIA DR",
"city": "FAIR LAWN",
"state": "NJ",
"postal_code": "074105104",
"telephone_number": "201-796-6188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 PROSPECT ST",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "074504404",
"telephone_number": "201-447-2242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RISKIN",
"first_name": "ANDREA",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-18",
"last_updated": "2018-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35S100504300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.