Basic Information
| Provider Information | |||||||||
| NPI: | 1215012232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZUCCONI | ||||||||
| FirstName: | FRED | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 MARTIN AVE | ||||||||
| Address2: | |||||||||
| City: | BARRINGTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028062641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013311350 | ||||||||
| FaxNumber: | 4012773366 | ||||||||
| Practice Location | |||||||||
| Address1: | 154 WARREN AVE UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | EAST PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029145159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014344120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 11/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01214 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 1027414 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 30311-2 | 01 | BLUE CROSS/SHIELD | OTHER | FM49368 | 05 | RI | MEDICAID | 407070 | 01 | BLUE CHIP | OTHER | 62-76970 | 01 | RI | UNITED BEHAVIORAL HEALTH | OTHER | 1023290 | 01 | RI | GROUP BEACON HEALTH | OTHER |