Provider Demographics
NPI:1326546110
Name:MARIA KATRINA RICCA, LLC
Entity Type:Organization
Organization Name:MARIA KATRINA RICCA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:408-205-9336
Mailing Address - Street 1:58 WHALERS PT
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4846
Mailing Address - Country:US
Mailing Address - Phone:408-205-9336
Mailing Address - Fax:
Practice Address - Street 1:847 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3456
Practice Address - Country:US
Practice Address - Phone:408-205-9336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001960251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health