Healthcare Provider Details

I. General information

NPI: 1215012232
Provider Name (Legal Business Name): FRED ZUCCONI LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

49 ROGER WILLIAMS AVE
RUMFORD RI
02916-2811
US

V. Phone/Fax

Practice location:
  • Phone: 401-386-7984
  • Fax:
Mailing address:
  • Phone: 401-386-7984
  • Fax: 401-528-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01214
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1027414
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: