Provider Demographics
NPI:1346549672
Name:PISELLI, ALESSANDRO TOMASO (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALESSANDRO
Middle Name:TOMASO
Last Name:PISELLI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:SANDRO
Other - Middle Name:
Other - Last Name:PISELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:323 BOSTON POST RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3022
Mailing Address - Country:US
Mailing Address - Phone:617-506-9012
Mailing Address - Fax:
Practice Address - Street 1:323 BOSTON POST RD STE 1A
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3022
Practice Address - Country:US
Practice Address - Phone:617-506-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA10051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health