Provider Demographics
NPI:1083676282
Name:MARCHETTA, RICKY JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:JOSEPH
Last Name:MARCHETTA
Suffix:
Gender:M
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 1898
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-1898
Mailing Address - Country:US
Mailing Address - Phone:985-781-7191
Mailing Address - Fax:
Practice Address - Street 1:119 VILLAGE ST
Practice Address - Street 2:STE A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5301
Practice Address - Country:US
Practice Address - Phone:985-781-9713
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T145Medicare ID - Type Unspecified