Healthcare Provider Details

I. General information

NPI: 1629213954
Provider Name (Legal Business Name): MRS. CARLA S RICCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ONECO ST
NORWICH CT
06360-3440
US

IV. Provider business mailing address

102 FITCHVILLE RD
BOZRAH CT
06334-1127
US

V. Phone/Fax

Practice location:
  • Phone: 860-416-3814
  • Fax:
Mailing address:
  • Phone: 860-416-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001495
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: