Healthcare Provider Details

I. General information

NPI: 1982169884
Provider Name (Legal Business Name): STEFANIE RICO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8461 LAKE WORTH RD
WELLINGTON FL
33467-2474
US

IV. Provider business mailing address

8461 LAKE WORTH RD
WELLINGTON FL
33467-2474
US

V. Phone/Fax

Practice location:
  • Phone: 561-790-1191
  • Fax:
Mailing address:
  • Phone: 561-790-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: