Individual
MR. MARK A RICKETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
1565 HERZEL BLVD, WEST BABYLON, NY 11704-4234
(646) 649-6840
Mailing address
1565 HERZEL BLVD, WEST BABYLON, NY 11704-4234
(646) 649-6840
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F404433
NY
Other
Enumeration date
12/20/2012
Last updated
09/28/2022
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