Provider Demographics
NPI:1568907186
Name:RICCABONI, LESLIE ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:RICCABONI
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 1:11101 OSWALT ROAD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9392
Mailing Address - Country:US
Mailing Address - Phone:352-283-2623
Mailing Address - Fax:
Practice Address - Street 1:214 E WASHINGTON STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-9227
Practice Address - Country:US
Practice Address - Phone:352-283-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW185281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW18528OtherSTATE OF FLORIDA LICENSE