Healthcare Provider Details

I. General information

NPI: 1568680452
Provider Name (Legal Business Name): ANTHONY MICHAEL RICCI PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5085 LIST DR STE 110
COLORADO SPRINGS CO
80919-3313
US

IV. Provider business mailing address

5085 LIST DR STE 110
COLORADO SPRINGS CO
80919-3313
US

V. Phone/Fax

Practice location:
  • Phone: 719-594-4407
  • Fax: 719-594-4409
Mailing address:
  • Phone: 719-594-4407
  • Fax: 719-594-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number416
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: