Provider Demographics
NPI:1417238429
Name:RICCI, JAMES ALBERT
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALBERT
Last Name:RICCI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 2ND ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2701
Mailing Address - Country:US
Mailing Address - Phone:415-456-6655
Mailing Address - Fax:415-456-0331
Practice Address - Street 1:1601 2ND ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2701
Practice Address - Country:US
Practice Address - Phone:415-456-6655
Practice Address - Fax:415-456-0331
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02031005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)