Provider Demographics
NPI:1609445758
Name:PICCIRILLO, ANDREA M (MA, CAGS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:PICCIRILLO
Suffix:
Gender:F
Credentials:MA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-3524
Mailing Address - Country:US
Mailing Address - Phone:401-524-5693
Mailing Address - Fax:
Practice Address - Street 1:1 SAGE DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-3524
Practice Address - Country:US
Practice Address - Phone:401-524-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool