Healthcare Provider Details

I. General information

NPI: 1427648211
Provider Name (Legal Business Name): RENE NICOLETTI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 SMITH ST
PROVIDENCE RI
02908-3770
US

IV. Provider business mailing address

3 LINCOLN DR
JOHNSTON RI
02919-2861
US

V. Phone/Fax

Practice location:
  • Phone: 401-589-1047
  • Fax:
Mailing address:
  • Phone: 860-614-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW03216
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: