Provider Demographics
NPI:1477258796
Name:RICARDO, MIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:M
Last Name:RICARDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S. WASHINGTON ST.
Mailing Address - Street 2:PO BOX 743
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02761-0743
Mailing Address - Country:US
Mailing Address - Phone:774-314-1231
Mailing Address - Fax:
Practice Address - Street 1:361 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2323
Practice Address - Country:US
Practice Address - Phone:774-420-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic