Basic Information
| Provider Information | |||||||||
| NPI: | 1205271228 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICCARDI | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 MAHAN CENTER BLVD | ||||||||
| Address2: | 116-PSYCHOLOGY SERVICE | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505215700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1615 MAHAN CENTER BLVD | ||||||||
| Address2: | 116-PSYCHOLOGY SERVICE | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505215700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2013 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4505 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.