Healthcare Provider Details

I. General information

NPI: 1134645856
Provider Name (Legal Business Name): STEPHEN R RICCO LADC1, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 DOUGLAS AVE STE 1
N PROVIDENCE RI
02904-4052
US

IV. Provider business mailing address

1405 DOUGLAS AVE STE 1
N PROVIDENCE RI
02904-4052
US

V. Phone/Fax

Practice location:
  • Phone: 401-601-5476
  • Fax:
Mailing address:
  • Phone: 401-601-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19440
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04273
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: