Provider Demographics
NPI:1336478692
Name:PACIARELLI, JR., EUGENE JOSEPH JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JOSEPH
Last Name:PACIARELLI, JR.
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16781
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29606-7781
Mailing Address - Country:US
Mailing Address - Phone:864-417-9668
Mailing Address - Fax:
Practice Address - Street 1:301 RUTHERFORD ST STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5309
Practice Address - Country:US
Practice Address - Phone:864-417-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3787103TC0700X
SC1313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0575Medicaid