Provider Demographics
NPI:1942385455
Name:RICCHETTI, JEANINE ANN (M S)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:ANN
Last Name:RICCHETTI
Suffix:
Gender:F
Credentials:M S
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 845
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-0845
Mailing Address - Country:US
Mailing Address - Phone:386-425-3935
Mailing Address - Fax:
Practice Address - Street 1:1951 NW 7TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1112
Practice Address - Country:US
Practice Address - Phone:305-902-6347
Practice Address - Fax:727-306-8033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP2005101YA0400X
FLMH7331101YM0800X
FL7331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)