Provider Demographics
NPI:1215075304
Name:DILLARD, RICO J
Entity type:Individual
Prefix:MR
First Name:RICO
Middle Name:J
Last Name:DILLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 MAPLE AVE
Mailing Address - Street 2:B-3
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120
Mailing Address - Country:US
Mailing Address - Phone:412-461-1004
Mailing Address - Fax:412-461-1325
Practice Address - Street 1:1705 MAPLE ST
Practice Address - Street 2:B-3
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1800
Practice Address - Country:US
Practice Address - Phone:412-461-1004
Practice Address - Fax:412-461-1325
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker