| Doctor Name: | DR. EDMUND LEIGH RICCIO |
| NPI Number: | 1497102438 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | PS017534 |
| Business Practice Address: | 800 E Lancaster Ave Villanova, PA - 190851603 |
| Business Phone Number: | 6102487465 |
| Business Fax Number: | |
| Mailing Address: | 632 Edinburgh Dr, WEST CHESTER |
| State: | PA |
| Postal Code: | 193827912 |
| Phone Number: | 6102487465 |
| Fax Number: | |
| NPI Enumeration Date: | 05/19/2016 |
| NPI Last Update Date: | 05/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PS017534 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |