Provider Demographics
NPI:1790338101
Name:RITTA, CARLENE ROSE (LIMHP)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:ROSE
Last Name:RITTA
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:ROSE
Other - Last Name:REICHMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5858
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5858
Mailing Address - Country:US
Mailing Address - Phone:308-381-7487
Mailing Address - Fax:308-381-2712
Practice Address - Street 1:3532 W CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1205
Practice Address - Country:US
Practice Address - Phone:308-381-7487
Practice Address - Fax:308-381-2712
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2886101YM0800X
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health