Provider Demographics
NPI:1427310291
Name:ANNA S RICKELL LCSW PC
Entity type:Organization
Organization Name:ANNA S RICKELL LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS IN SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:914-714-3816
Mailing Address - Street 1:210 N RADCLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5389
Mailing Address - Country:US
Mailing Address - Phone:914-714-3816
Mailing Address - Fax:864-541-7723
Practice Address - Street 1:210 N RADCLIFF WAY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5389
Practice Address - Country:US
Practice Address - Phone:914-714-3816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0269521251S00000X
MD12432251S00000X
SC8471251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health