Healthcare Provider Details

I. General information

NPI: 1891765467
Provider Name (Legal Business Name): JAMES JOHN PICANO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD VA NCHCS MENTAL HEALTH SERVICE
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

5005 SLEEPY HOLLOW LN
FAIRFIELD CA
94534-9756
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone: 707-421-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY11949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: