Provider Demographics
NPI:1588625008
Name:RICKS, NANCY L (EDD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:RICKS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CLYFTON ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3904
Mailing Address - Country:US
Mailing Address - Phone:508-747-6907
Mailing Address - Fax:508-746-8456
Practice Address - Street 1:16 ALDRIN RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4804
Practice Address - Country:US
Practice Address - Phone:508-747-6907
Practice Address - Fax:508-746-8456
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1859103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0515868Medicaid
MA0515868Medicaid