Provider Demographics
NPI:1386833911
Name:LUIGI PICIUCCO PHD INC
Entity Type:Organization
Organization Name:LUIGI PICIUCCO PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:PICIUCCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-361-7188
Mailing Address - Street 1:9700 BUSINESS PARK DRIVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1717
Mailing Address - Country:US
Mailing Address - Phone:916-361-7188
Mailing Address - Fax:916-361-3984
Practice Address - Street 1:9700 BUSINESS PARK DRIVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1717
Practice Address - Country:US
Practice Address - Phone:916-361-7188
Practice Address - Fax:916-361-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8312103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL83120Medicare PIN