Provider Demographics
NPI:1639638075
Name:RICCI, ALEXIS (M ED, LBS)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:RICCI
Suffix:
Gender:F
Credentials:M ED, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3805
Mailing Address - Country:US
Mailing Address - Phone:610-937-0649
Mailing Address - Fax:
Practice Address - Street 1:126 BEECHWOOD RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3805
Practice Address - Country:US
Practice Address - Phone:610-937-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst