Provider Demographics
NPI:1174176614
Name:RIDEAUX, CRISTIAN (LCSW)
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:
Last Name:RIDEAUX
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 1:2002 SHARI LYNN TER
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3216
Mailing Address - Country:US
Mailing Address - Phone:225-247-0148
Mailing Address - Fax:
Practice Address - Street 1:17011 STATE ROAD 50 STE 301
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8203
Practice Address - Country:US
Practice Address - Phone:352-833-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW13740104100000X
FLSW187521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker