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General NPI Number Information
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NPI Number | 1205973765
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Entity Type | Individual
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Provider Name | TRACY RICCA-MULLAHEY M.A.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 500 WHITE PELICAN CIR
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City | VERO BEACH
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State | FL
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Zip | 32963-9519
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Country | US
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Telephone | 516-238-6259
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Fax |
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Provider Business Mailing Address
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Address Line | 127 LEFFERTS RD
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City | GARDEN CITY
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State | NY
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Zip | 11530-1734
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Country | US
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Telephone | 516-294-9358
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 009763
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License Number State | NY
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