Healthcare Provider Details

I. General information

NPI: 1568366698
Provider Name (Legal Business Name): SCOTT MICHAEL RICENBERG MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10I ROESSLER RD
WOBURN MA
01801-6208
US

IV. Provider business mailing address

43 PRESCOTT ST APT 11
CONCORD NH
03301-6150
US

V. Phone/Fax

Practice location:
  • Phone: 781-932-8114
  • Fax:
Mailing address:
  • Phone: 845-242-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: