Provider Demographics
NPI:1013584168
Name:PICCOLINO, AMANDA (MSC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PICCOLINO
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1725
Mailing Address - Country:US
Mailing Address - Phone:978-306-5199
Mailing Address - Fax:508-449-3962
Practice Address - Street 1:144 MERRIMACK ST STE 302
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1710
Practice Address - Country:US
Practice Address - Phone:978-306-5199
Practice Address - Fax:508-449-3962
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker