Healthcare Provider Details

I. General information

NPI: 1033652375
Provider Name (Legal Business Name): JOSEPH PAUL PICCINNINI SR. MA, LCAT, CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PAGE AVE
STATEN ISLAND NY
10309-2611
US

IV. Provider business mailing address

25 PAGE AVE
STATEN ISLAND NY
10309
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-4686
  • Fax:
Mailing address:
  • Phone: 718-967-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: