Healthcare Provider Details

I. General information

NPI: 1972482800
Provider Name (Legal Business Name): SETH PICCOLO SR. LCDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705A OLD POST RD
CHARLESTOWN RI
02813-1842
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-364-7705
  • Fax: 401-364-1982
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP01060
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: