Provider Demographics
NPI:1497102438
Name:RICCIO, EDMUND LEIGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:LEIGH
Last Name:RICCIO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7912
Mailing Address - Country:US
Mailing Address - Phone:610-248-7465
Mailing Address - Fax:
Practice Address - Street 1:800 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1603
Practice Address - Country:US
Practice Address - Phone:610-248-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical