Provider Demographics
NPI:1124558499
Name:RICCA-CALDON, GABRIELLE MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARIE
Last Name:RICCA-CALDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 PARK AVE STE 380
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7573
Mailing Address - Country:US
Mailing Address - Phone:917-581-2834
Mailing Address - Fax:
Practice Address - Street 1:775 PARK AVE STE 380
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7573
Practice Address - Country:US
Practice Address - Phone:917-581-2834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011337-01101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health