Provider Demographics
NPI:1588973119
Name:RICCIO, CYNTHIA A (PHD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:RICCIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF EDUCATIONAL PSYCHOLOGY
Mailing Address - Street 2:TAMU 4225
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-4225
Mailing Address - Country:US
Mailing Address - Phone:979-862-4906
Mailing Address - Fax:
Practice Address - Street 1:1318 MEMORIAL DRIVE
Practice Address - Street 2:BRAZOS VALLEY REHABILITATION CENTER
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-862-4906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31026103T00000X
TX30663103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool