Provider Demographics
NPI:1962241620
Name:RICCIARDI, BENJAMIN CLEVELAND (MA, COUNSELLING)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CLEVELAND
Last Name:RICCIARDI
Suffix:
Gender:M
Credentials:MA, COUNSELLING
Other - Prefix:MR
Other - First Name:BENJAMIN
Other - Middle Name:JUSTIN
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, COUNSELLING
Mailing Address - Street 1:225 S MERAMEC AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3511
Mailing Address - Country:US
Mailing Address - Phone:636-728-9152
Mailing Address - Fax:
Practice Address - Street 1:225 S MERAMEC AVE STE 408
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3511
Practice Address - Country:US
Practice Address - Phone:636-728-9152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023015643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional