Provider Demographics
NPI:1962403246
Name:RICALDI, MARTHA N (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:N
Last Name:RICALDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER
Mailing Address - Street 2:36000 DARNALL LOOP
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CRDAMC DEPARTMENT OF SOCIAL WORK
Practice Address - Street 2:BLDG. 2255 52ND & 761ST TANK BATALLION ROAD
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-4752
Practice Address - Country:US
Practice Address - Phone:254-288-6474
Practice Address - Fax:254-288-3281
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW50401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7655525 00Medicaid
FLSW5040OtherQUALIFIED SUPERVISOR
FLSW5040OtherCLINICAL LICENSE