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General NPI Number Information
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NPI Number | 1649764663
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Entity Type | Individual
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Provider Name | DEIDRE ANN RICKETTS
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Gender | Female
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 2001 W BLUE HERON BLVD
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-5003
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Country | US
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Telephone | 561-840-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 N CONGRESS AVE APT 226
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-1729
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Country | US
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Telephone | 561-670-5100
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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 |
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License Number State |
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