Healthcare Provider Details

I. General information

NPI: 1174192371
Provider Name (Legal Business Name): JORGE PICCOLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PLAISTOW RD
HAVERHILL MA
01830-1443
US

IV. Provider business mailing address

10 MECHANIC ST STE 302
WORCESTER MA
01608-2419
US

V. Phone/Fax

Practice location:
  • Phone: 978-373-4985
  • Fax:
Mailing address:
  • Phone: 508-792-5400
  • Fax: 508-831-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1142974
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: