Provider Demographics
NPI:1215012232
Name:ZUCCONI, FRED (LICSW)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:ZUCCONI
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-2641
Mailing Address - Country:US
Mailing Address - Phone:401-331-1350
Mailing Address - Fax:401-277-3366
Practice Address - Street 1:154 WARREN AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5159
Practice Address - Country:US
Practice Address - Phone:401-434-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW012141041C0700X
MA10274141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
30311-2OtherBLUE CROSS/SHIELD
RIFM49368Medicaid
407070OtherBLUE CHIP
RI62-76970OtherUNITED BEHAVIORAL HEALTH
RI1023290OtherGROUP BEACON HEALTH