Provider Demographics
NPI:1871779173
Name:TERESA M PICCIOCCHI PSYD INC
Entity type:Organization
Organization Name:TERESA M PICCIOCCHI PSYD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICCIOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-337-0551
Mailing Address - Street 1:4965 SW 91ST TER
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8149
Mailing Address - Country:US
Mailing Address - Phone:352-337-0551
Mailing Address - Fax:
Practice Address - Street 1:4965 SW 91ST TER
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8149
Practice Address - Country:US
Practice Address - Phone:352-337-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty