Healthcare Provider Details

I. General information

NPI: 1477691590
Provider Name (Legal Business Name): LUIGI PICIUCCO PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 BUSINESS PARK DRIVE SUITE 207
SACRAMENTO CA
95827-1717
US

IV. Provider business mailing address

9700 BUSINESS PARK DRIVE SUITE 207
SACRAMENTO CA
95827-1717
US

V. Phone/Fax

Practice location:
  • Phone: 916-361-7188
  • Fax: 934-361-3984
Mailing address:
  • Phone: 916-361-7188
  • Fax: 934-361-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY8312
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY8312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: