Individual
BRIAN DICICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
591 ADMIRAL ST, PROVIDENCE, RI 02908-1541
(401) 383-2546
Mailing address
591 ADMIRAL ST, PROVIDENCE, RI 02908-1541
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC00990
RI
Other
Enumeration date
09/02/2016
Last updated
10/29/2018
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