Healthcare Provider Details

I. General information

NPI: 1588625008
Provider Name (Legal Business Name): NANCY L. RICKS ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ALDRIN RD
PLYMOUTH MA
02360-4804
US

IV. Provider business mailing address

18 CLYFTON ST
PLYMOUTH MA
02360-3904
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-6907
  • Fax: 508-746-8456
Mailing address:
  • Phone: 508-747-6907
  • Fax: 508-746-8456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1859
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1859
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: