Healthcare Provider Details

I. General information

NPI: 1083821425
Provider Name (Legal Business Name): RICCI C ROBSON LMHC, CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N HIATUS RD #213
PEMBROKE PINES FL
33026-5206
US

IV. Provider business mailing address

2300 PARK LN APT 203
HOLLYWOOD FL
33021-3768
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-0411
  • Fax: 954-431-0413
Mailing address:
  • Phone: 954-665-9536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: