Basic Information
Provider Information
NPI: 1912281502
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAVATKA
FirstName: RITA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: LCSW-R
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LOMBARDO
OtherFirstName: RITA
OtherMiddleName: MARY
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 9 CAREY RD
Address2:  
City: QUEENSBURY
State: NY
PostalCode: 128047880
CountryCode: US
TelephoneNumber: 5187610300
FaxNumber: 5188242388
Practice Location
Address1: 3767 MAIN ST
Address2:  
City: WARRENSBURG
State: NY
PostalCode: 12885
CountryCode: US
TelephoneNumber: 5186232844
FaxNumber: 5186233416
Other Information
ProviderEnumerationDate: 09/30/2011
LastUpdateDate: 03/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XR033439NYY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home