Provider Demographics
NPI:1447334925
Name:PICHIOTINO, RICHARD L (LLP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:PICHIOTINO
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31451 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-7308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16664 15 MILE RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3713
Practice Address - Country:US
Practice Address - Phone:586-294-3030
Practice Address - Fax:586-294-0805
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008646103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist