Healthcare Provider Details

I. General information

NPI: 1033262720
Provider Name (Legal Business Name): ANGELA PICCININNI LCSW R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GRAND AVE
MASSAPEQUA NY
11758-4905
US

IV. Provider business mailing address

75 GRAND AVE
MASSAPEQUA NY
11758-4905
US

V. Phone/Fax

Practice location:
  • Phone: 519-799-3203
  • Fax:
Mailing address:
  • Phone: 519-799-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25738
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR075738-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: