# NICKERSON COMMUNITY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457549578
- **Authorized official:** LISA D'AMBRA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (401) 351-2241

## Contact information

- **Practice address:** 97 DELAINE ST, PROVIDENCE, RI 02909-2726
- **Practice address phone:** (401) 383-5672
- **Mailing address:** 133 DELAINE ST, PROVIDENCE, RI 02909-2728
- **Mailing address phone:** (401) 351-2241

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 10/15/2007
- **Last updated:** 10/15/2007