Provider Demographics
NPI:1164643474
Name:PICCIRILLO, PATRICIA (LPC,LSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PICCIRILLO
Suffix:
Gender:F
Credentials:LPC,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:LOWELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44436
Mailing Address - Country:US
Mailing Address - Phone:339-536-6358
Mailing Address - Fax:
Practice Address - Street 1:611 BELMONT AVENUE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502
Practice Address - Country:US
Practice Address - Phone:330-744-2991
Practice Address - Fax:330-746-3449
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC4822101YM0800X
OHS438104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker