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Phillip Riddick

Social Worker

Behavioral Health & Social Service Providers

733 Thimble Shoals Blvd, Ste. 170, Newport News, VA 23606-4260

PECOS Enrollment

Based on the most recent information from CMS, provider Phillip Riddick is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1801272208
Provider Type
Individual
Full Name
Riddick, Phillip
Credential
LCSW

Gender
Male
Sole Proprietor
Yes
Enumeration Date
8/7/2015
Last Updated
8/7/2015

Contact Information

Practice Location

733 Thimble Shoals Blvd, Ste. 170, Newport News, VA 23606-4260

(757) 301-1314

Unlisted Fax

Mailing Location

2121b Keller Ave, Norfolk, VA 23504-3106

(757) 679-2583

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 0904009046 Virginia

Phillip Riddick

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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