Healthcare Provider Details

I. General information

NPI: 1578139945
Provider Name (Legal Business Name): JAMES ROBERT RYCZEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 CRANSTON ST
CRANSTON RI
02920-7323
US

IV. Provider business mailing address

1090 CRANSTON ST
CRANSTON RI
02920-7323
US

V. Phone/Fax

Practice location:
  • Phone: 401-286-0829
  • Fax:
Mailing address:
  • Phone: 401-286-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01261
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: