Provider Demographics
NPI:1154561462
Name:RICCI, BRITT ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRITT
Middle Name:ROSE
Last Name:RICCI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10117 SE SUNNYSIDE RD # F1217
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7708
Mailing Address - Country:US
Mailing Address - Phone:503-740-1971
Mailing Address - Fax:503-771-2436
Practice Address - Street 1:417 SE 164TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8943
Practice Address - Country:US
Practice Address - Phone:503-740-1971
Practice Address - Fax:503-771-2436
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601596401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8911829Medicare UPIN