Provider Demographics
NPI:1528667110
Name:RICCARDI, SAHRA B (ATR-BC, LPC)
Entity type:Individual
Prefix:
First Name:SAHRA
Middle Name:B
Last Name:RICCARDI
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MAIN ST STE 6503
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1527
Mailing Address - Country:US
Mailing Address - Phone:315-271-7043
Mailing Address - Fax:
Practice Address - Street 1:25 S MAIN ST STE 6503
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1527
Practice Address - Country:US
Practice Address - Phone:315-271-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health