Provider Demographics
NPI:1356829923
Name:RICO, DENISE AMANDA
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:AMANDA
Last Name:RICO
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 1:100 LUNA PARK DR APT 131
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-3152
Mailing Address - Country:US
Mailing Address - Phone:915-252-0458
Mailing Address - Fax:
Practice Address - Street 1:100 LUNA PARK DR APT 131
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-3152
Practice Address - Country:US
Practice Address - Phone:915-252-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician