Provider Demographics
NPI:1679840201
Name:FUOCO, NICOLE MOLLICA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MOLLICA
Last Name:FUOCO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MOLLICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:25 DEVEREUX ST
Mailing Address - Street 2:204
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-5556
Mailing Address - Country:US
Mailing Address - Phone:401-437-7669
Mailing Address - Fax:
Practice Address - Street 1:31 DEVEREUX ST
Practice Address - Street 2:204
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-5551
Practice Address - Country:US
Practice Address - Phone:401-437-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2014-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW014501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical