Provider Demographics
NPI:1114116803
Name:RICCI, LOUIS LEO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:LEO
Last Name:RICCI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DAVID CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1156
Mailing Address - Country:US
Mailing Address - Phone:516-578-4417
Mailing Address - Fax:
Practice Address - Street 1:21 DAVID CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1156
Practice Address - Country:US
Practice Address - Phone:516-578-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017304103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist