Healthcare Provider Details

I. General information

NPI: 1770249773
Provider Name (Legal Business Name): ROMAN PICARELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date: 10/24/2024
Reactivation Date: 12/12/2024

III. Provider practice location address

7530 E ANGUS DR
SCOTTSDALE AZ
85251-6410
US

IV. Provider business mailing address

7530 E ANGUS DR
SCOTTSDALE AZ
85251-6410
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-5739
  • Fax:
Mailing address:
  • Phone: 480-947-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23167
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: