Provider Demographics
NPI:1780037085
Name:RICARDO, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:RICARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 SE 9TH AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 SE 9TH AVE
Practice Address - Street 2:APT 4
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5912
Practice Address - Country:US
Practice Address - Phone:786-333-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT 1507122103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst