Provider Demographics
NPI:1588239925
Name:RICCOBONO, HELEN DAWN (MA, AMFT)
Entity Type:Individual
Prefix:MS
First Name:HELEN
Middle Name:DAWN
Last Name:RICCOBONO
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28081 MARGUERITE PARKWAY
Mailing Address - Street 2:PO BOX 4143
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-1800
Mailing Address - Country:US
Mailing Address - Phone:949-742-4627
Mailing Address - Fax:
Practice Address - Street 1:3068 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2819
Practice Address - Country:US
Practice Address - Phone:949-742-4627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist