Provider Demographics
NPI:1619202124
Name:RISUCCI, DANA MARIE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:RISUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:RISUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2200 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7387
Mailing Address - Country:US
Mailing Address - Phone:561-860-2479
Mailing Address - Fax:561-807-6807
Practice Address - Street 1:2200 NW CORPORATE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7387
Practice Address - Country:US
Practice Address - Phone:561-860-2479
Practice Address - Fax:561-807-6807
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW95481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical