Provider Demographics
NPI:1154318368
Name:RICO, KEVIN M (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:RICO
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 1:1720 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3911
Mailing Address - Country:US
Mailing Address - Phone:724-863-3539
Mailing Address - Fax:
Practice Address - Street 1:624 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3407
Practice Address - Country:US
Practice Address - Phone:724-863-0226
Practice Address - Fax:724-863-0226
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0136431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001914725OtherCOMMUNITY CARE BEHAVIORAL
PA104639OtherUNITED BEHAVIORAL HEALTH
PA324665OtherUPMC INSURANCE
PA454660OtherVALUE OPTIONS
PA559672OtherBLUE CROSS BLUE SHIELD
PA454660OtherVALUE BEHAVIORAL HEALTH
PA559672OtherMAGELLAN INSURANCE
PA0019147250001Medicaid
PA0019147250001Medicaid