Provider Demographics
NPI:1275608135
Name:RICKELL, ANNA S (MS)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:S
Last Name:RICKELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N RADCLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5389
Mailing Address - Country:US
Mailing Address - Phone:914-714-3816
Mailing Address - Fax:864-541-7286
Practice Address - Street 1:210 N RADCLIFF WAY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5389
Practice Address - Country:US
Practice Address - Phone:914-714-3816
Practice Address - Fax:864-541-7286
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0269521104100000X
MD12432104100000X
SC8471104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ349420281OtherMEDICARE
MD138773OtherMEDICARE