Provider Demographics
NPI:1417992124
Name:RICKETTS, MARY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16560 W WOODLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2725
Mailing Address - Country:US
Mailing Address - Phone:602-285-9696
Mailing Address - Fax:602-277-5930
Practice Address - Street 1:5050 N 8TH PL
Practice Address - Street 2:SUITE 8
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3202
Practice Address - Country:US
Practice Address - Phone:602-285-9696
Practice Address - Fax:602-277-5930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 11539101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health