Provider Demographics
NPI:1235584277
Name:RICO, TAMYRA L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMYRA
Middle Name:L
Last Name:RICO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CENTERVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4347
Mailing Address - Country:US
Mailing Address - Phone:401-921-8713
Mailing Address - Fax:401-921-1890
Practice Address - Street 1:501 CENTERVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4347
Practice Address - Country:US
Practice Address - Phone:401-921-8713
Practice Address - Fax:401-921-1890
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW026181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical