Individual provider Active NPI

Deidre Ann Ricketts

  • Clinical Social Worker
  • Riviera Beach, FL
National Provider Identifier
1649764663
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
2001 W Blue Heron Blvd
Riviera Beach, FL 33404-5003
Phone
(561) 840-3500
NPI assigned
Jun 22, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

2001 W Blue Heron Blvd
Riviera Beach, FL 33404-5003

Mailing address

1625 N Congress Ave Apt 226
West Palm Beach, FL 33401-1729
Phone (561) 670-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220727001951 FL Practitioner - Clinical Social Worker 0143602821 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mtca Psychological Services P.a. CurrentSince Sep 15, 2022 Accepting new patients
Shine Medical Providers PC Past Accepting new patients

Locations

7091 Atlantic Ave
Delray Beach, FL 33446
Phone (561) 558-2149

16853 NE 2nd Ave
Ste S304
North Miami Beach, FL 33162

301 Ebbtide Dr
North Palm Beach, FL 33408
Phone (561) 844-0012

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1649764663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 N CONGRESS AVE APT 226",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334011729",
            "telephone_number": "561-670-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 W BLUE HERON BLVD",
            "city": "RIVIERA BEACH",
            "state": "FL",
            "postal_code": "334045003",
            "telephone_number": "561-840-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKETTS",
        "first_name": "DEIDRE ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-22",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riviera Beach, FL

Sources for this page

Verify at the official NPI Registry.