Provider Demographics
NPI:1144319641
Name:RICCIO, LAURIE MANSFIELD (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:MANSFIELD
Last Name:RICCIO
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 1:371 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3439
Mailing Address - Country:US
Mailing Address - Phone:401-751-7358
Mailing Address - Fax:
Practice Address - Street 1:100 LAFAYETTE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6008
Practice Address - Country:US
Practice Address - Phone:401-722-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW008571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical