Provider Demographics
NPI:1578365797
Name:RIDDICK, SAQUANA (CASAC-T)
Entity type:Individual
Prefix:
First Name:SAQUANA
Middle Name:
Last Name:RIDDICK
Suffix:
Gender:
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 BUSHWICK AVE APT 4I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3734
Mailing Address - Country:US
Mailing Address - Phone:929-603-4926
Mailing Address - Fax:
Practice Address - Street 1:370 BUSHWICK AVE APT 4I
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3734
Practice Address - Country:US
Practice Address - Phone:929-603-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38074101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)