Provider Demographics
NPI:1225123946
Name:PICCOLINO, JOY PAMELA (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:PAMELA
Last Name:PICCOLINO
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12940 HARRIET AVE S
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2680
Mailing Address - Country:US
Mailing Address - Phone:952-435-4074
Mailing Address - Fax:952-435-6074
Practice Address - Street 1:12940 HARRIET AVE S
Practice Address - Street 2:SUITE 250
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2680
Practice Address - Country:US
Practice Address - Phone:952-435-4074
Practice Address - Fax:952-435-6074
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4179103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5572177-00Medicaid