MEDICARE: MS. CHRISTIE RICCARDI LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LMSW-16273	AZ

General Provider Information

NPI Number	:	1275074247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTIE RICCARDI LMSW

Provider Business Mailing Address
First Line	:	PO BOX 45422
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-5422
Country	:	US
Telephone Number	:	763-222-7418
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 W CHANDLER BLVD # A
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-2548
Country	:	US
Telephone Number	:	480-899-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	03/10/2017

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