Provider Demographics
NPI:1437288206
Name:RICOTTA, PHILIP F (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:RICOTTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 SWEET HOME ROAD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228
Mailing Address - Country:US
Mailing Address - Phone:716-634-0566
Mailing Address - Fax:716-634-8040
Practice Address - Street 1:1404 SWEET HOME ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228
Practice Address - Country:US
Practice Address - Phone:716-634-0566
Practice Address - Fax:716-634-8040
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0090841103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020913101OtherUNIVERA INS
NY6109125OtherIHA INS
NY6109125OtherIHA INS