Healthcare Provider Details

I. General information

NPI: 1710840376
Provider Name (Legal Business Name): MICHAEL S. PIGNATO LADC2
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 MAIN ST STE 100
WALTHAM MA
02452-5559
US

IV. Provider business mailing address

564 MAIN ST STE 100
WALTHAM MA
02452-5559
US

V. Phone/Fax

Practice location:
  • Phone: 833-287-7223
  • Fax: 781-614-0659
Mailing address:
  • Phone: 833-287-7223
  • Fax: 781-614-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24767
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: