Healthcare Provider Details

I. General information

NPI: 1477824431
Provider Name (Legal Business Name): NICOLE RIDZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MARION AVE NW
MASSILLON OH
44646-3639
US

IV. Provider business mailing address

323 MARION AVE NW
MASSILLON OH
44646-3639
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-3313
  • Fax: 330-493-6413
Mailing address:
  • Phone: 330-493-3313
  • Fax: 330-493-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1100090
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: