Provider Demographics
NPI:1225612070
Name:PEREIRA PICCOLO RIBEIRO, MAYRON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAYRON
Middle Name:
Last Name:PEREIRA PICCOLO RIBEIRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:MAYRON
Other - Middle Name:
Other - Last Name:PEREIRA PICOLO RIBEIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:133 OXFORD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1546
Mailing Address - Country:US
Mailing Address - Phone:617-710-7982
Mailing Address - Fax:
Practice Address - Street 1:140 WOOD RD STE 300
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2514
Practice Address - Country:US
Practice Address - Phone:774-294-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst