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General NPI Number Information
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NPI Number | 1316084270
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Entity Type | Organization
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Legal Business Name | PICCOLINO PSYCHOLOGICAL SERVICES, PA
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 12940 HARRIET AVE S SUITE 250
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City | BURNSVILLE
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State | MN
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Zip | 55337-2680
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Country | US
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Telephone | 952-435-4074
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Fax | 952-435-6074
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Provider Business Mailing Address
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Address Line | 12940 HARRIET AVE S SUITE 250
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City | BURNSVILLE
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State | MN
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Zip | 55337-2680
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Country | US
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Telephone | 952-435-4074
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Fax | 952-435-6074
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Authorized Official
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Title or Position | CEO
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Name | DR. JOY PICCOLINO
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Credential | PSYD, LP
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Telephone | 952-435-4074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP4179
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License Number State | MN
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