Provider Demographics
NPI:1396861191
Name:PECORONI, RICHARD WILLIAM (MA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:PECORONI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3017 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4977
Mailing Address - Country:US
Mailing Address - Phone:203-333-1790
Mailing Address - Fax:203-870-9339
Practice Address - Street 1:3017 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4977
Practice Address - Country:US
Practice Address - Phone:203-333-1790
Practice Address - Fax:203-870-9339
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional