Provider Demographics
NPI:1447267067
Name:PICKELL, BRIAN (PSYD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PICKELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-9999
Mailing Address - Fax:
Practice Address - Street 1:42 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1156
Practice Address - Country:US
Practice Address - Phone:413-370-5285
Practice Address - Fax:413-370-5384
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6191104100000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0522058Medicaid
MAS63935Medicare UPIN
MAW50341Medicare ID - Type Unspecified