Healthcare Provider Details

I. General information

NPI: 1033279765
Provider Name (Legal Business Name): TERESA A. KEY-PICIUCCO PYSCH ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 W CHURCH ST STE 318
NEWARK OH
43055-5050
US

IV. Provider business mailing address

68 W CHURCH ST STE 318
NEWARK OH
43055-5050
US

V. Phone/Fax

Practice location:
  • Phone: 740-281-1777
  • Fax: 740-281-1778
Mailing address:
  • Phone: 740-281-1777
  • Fax: 740-281-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1291
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number821
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: