Healthcare Provider Details

I. General information

NPI: 1447267067
Provider Name (Legal Business Name): BRIAN PICKELL PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WRIGHT ST
PALMER MA
01069-1156
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-370-5285
  • Fax: 413-370-5384
Mailing address:
  • Phone: 413-794-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6191
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6191
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: