Provider Demographics
NPI:1699216036
Name:RICCI, AMANDA (LADC, CCS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RICCI
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:EAST DIXFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04227-0056
Mailing Address - Country:US
Mailing Address - Phone:207-320-3305
Mailing Address - Fax:207-645-2372
Practice Address - Street 1:76 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1529
Practice Address - Country:US
Practice Address - Phone:207-320-3305
Practice Address - Fax:207-645-2372
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECCS7464101YA0400X
MELC6593101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)