Provider Demographics
NPI:1265598494
Name:RICCARDO, JILL RILEY (MSW,, LCSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:RILEY
Last Name:RICCARDO
Suffix:
Gender:F
Credentials:MSW,, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082B WELLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1200
Mailing Address - Country:US
Mailing Address - Phone:859-223-2813
Mailing Address - Fax:859-296-2880
Practice Address - Street 1:1082B WELLINGTON WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1200
Practice Address - Country:US
Practice Address - Phone:859-223-2813
Practice Address - Fax:859-296-2880
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical