Provider Demographics
NPI:1174657324
Name:RICCA, TOBI (MSW, LICSW, FAAETS)
Entity Type:Individual
Prefix:MS
First Name:TOBI
Middle Name:
Last Name:RICCA
Suffix:
Gender:F
Credentials:MSW, LICSW, FAAETS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 124TH ST SW SPC 128
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-1846
Mailing Address - Country:US
Mailing Address - Phone:425-347-2677
Mailing Address - Fax:
Practice Address - Street 1:19101 36TH AVE W STE 208
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5759
Practice Address - Country:US
Practice Address - Phone:206-518-1332
Practice Address - Fax:425-347-2677
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000040321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04140091Medicaid
CO04140091Medicaid