Provider Demographics
NPI:1417300963
Name:RICCI, MICHAEL E (EDS, MED)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:RICCI
Suffix:
Gender:M
Credentials:EDS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 STARKEY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2175
Mailing Address - Country:US
Mailing Address - Phone:727-222-5682
Mailing Address - Fax:
Practice Address - Street 1:3030 STARKEY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-2175
Practice Address - Country:US
Practice Address - Phone:727-222-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health