| Doctor Name: | ANTHONY RICCOBONO |
| NPI Number: | 1245696293 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCADC |
| License Number: | 37LC00187200 |
| Business Practice Address: | 500 Main St Lan-lac Bldg 2 Suite 1 Lanoka Harbor, NJ - 087342228 |
| Business Phone Number: | 6092429500 |
| Business Fax Number: | 6092429502 |
| Mailing Address: | 500 Main St, Lan-lac Bldg 2 Suite 1 LANOKA HARBOR |
| State: | NJ |
| Postal Code: | 087342228 |
| Phone Number: | 6092429500 |
| Fax Number: | 6092429502 |
| NPI Enumeration Date: | 01/06/2016 |
| NPI Last Update Date: | 01/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00187200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |