Provider Demographics
NPI:1467085415
Name:RICCARDI, ROBIN ELIZABETH (NCC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ELIZABETH
Last Name:RICCARDI
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11819 S DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5635
Mailing Address - Country:US
Mailing Address - Phone:832-470-3425
Mailing Address - Fax:
Practice Address - Street 1:616 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1857
Practice Address - Country:US
Practice Address - Phone:832-470-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty