Healthcare Provider Details

I. General information

NPI: 1568698819
Provider Name (Legal Business Name): JENNIFER RENEE RICCI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N 17TH ST
OLEAN NY
14760-1924
US

IV. Provider business mailing address

109 N 17TH ST
OLEAN NY
14760-1924
US

V. Phone/Fax

Practice location:
  • Phone: 570-423-3894
  • Fax:
Mailing address:
  • Phone: 570-423-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: