Provider Demographics
NPI:1609196856
Name:RICCIARDI, JOSEPH N II (PSYD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:N
Last Name:RICCIARDI
Suffix:II
Gender:M
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:DEVENS
Mailing Address - State:MA
Mailing Address - Zip Code:01434-4468
Mailing Address - Country:US
Mailing Address - Phone:978-772-7172
Mailing Address - Fax:
Practice Address - Street 1:22 GRANT RD
Practice Address - Street 2:
Practice Address - City:DEVENS
Practice Address - State:MA
Practice Address - Zip Code:01434-4468
Practice Address - Country:US
Practice Address - Phone:978-772-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MA6220 HSP103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities