Provider Demographics
NPI:1144273442
Name:RISING, HEARTH MOON (LCSW)
Entity type:Individual
Prefix:MS
First Name:HEARTH
Middle Name:MOON
Last Name:RISING
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:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983
Mailing Address - Country:US
Mailing Address - Phone:515-897-2947
Mailing Address - Fax:518-897-2642
Practice Address - Street 1:2233 NY-86
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983
Practice Address - Country:US
Practice Address - Phone:518-897-2947
Practice Address - Fax:518-897-2947
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR064250-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP72498Medicare UPIN
NYDD3173Medicare ID - Type Unspecified