Provider Demographics
NPI:1801022652
Name:RICKETTS, YVONNE BARBARA
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:BARBARA
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:1425 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-2909
Mailing Address - Country:US
Mailing Address - Phone:561-506-8946
Mailing Address - Fax:
Practice Address - Street 1:1639 FORUM PL
Practice Address - Street 2:SUITE#7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2330
Practice Address - Country:US
Practice Address - Phone:561-712-8821
Practice Address - Fax:561-712-8020
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health