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 1:49 ROGER WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-2811
Mailing Address - Country:US
Mailing Address - Phone:401-386-7984
Mailing Address - Fax:401-528-0188
Practice Address - Street 1:530 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5762
Practice Address - Country:US
Practice Address - Phone:401-386-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2025-07-14
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
RI62-76970OtherUNITED BEHAVIORAL HEALTH
30311-2OtherBLUE CROSS/SHIELD
407070OtherBLUE CHIP
RIFM49368Medicaid
RI1023290OtherGROUP BEACON HEALTH