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General NPI Number Information
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NPI Number | 1083676282
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Entity Type | Individual
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Provider Name | RICKY JOSEPH MARCHETTA L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 119 VILLAGE ST STE A
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City | SLIDELL
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State | LA
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Zip | 70458-5301
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Country | US
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Telephone | 985-781-9713
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1898
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City | PURVIS
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State | MS
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Zip | 39475-1898
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Country | US
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Telephone | 985-781-7191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3269
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License Number State | LA
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