MEDICARE: MS. MARTHA N RICALDI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW5040	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	SW5040	OTHER	FL	QUALIFIED SUPERVISOR
3	SW5040	OTHER	FL	CLINICAL LICENSE

General Provider Information

NPI Number	:	1962403246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA N RICALDI LCSW

Provider Business Mailing Address
First Line	:	CARL R. DARNALL ARMY MEDICAL CENTER
Second Line	:	36000 DARNALL LOOP
City	:	FORT HOOD
State	:	TX
Zip	:	76544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	CRDAMC DEPARTMENT OF SOCIAL WORK
Second Line	:	BLDG. 2255 52ND & 761ST TANK BATALLION ROAD
City	:	FORT HOOD
State	:	TX
Zip	:	76544-4752
Country	:	US
Telephone Number	:	254-288-6474
Fax Number	:	254-288-3281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/09/2007

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