Provider Demographics
NPI:1831739762
Name:RICCIARDELLA, RITA MARIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MARIA
Last Name:RICCIARDELLA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-1456
Mailing Address - Country:US
Mailing Address - Phone:914-255-3063
Mailing Address - Fax:
Practice Address - Street 1:871 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-1456
Practice Address - Country:US
Practice Address - Phone:914-255-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist