Provider Demographics
NPI:1417013277
Name:PICCOLO, DEBRA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:PICCOLO
Suffix:
Gender:F
Credentials:LCSW
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 64002
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728
Mailing Address - Country:US
Mailing Address - Phone:520-327-5522
Mailing Address - Fax:520-327-5525
Practice Address - Street 1:1661 N SWAN RD
Practice Address - Street 2:SUITE 234
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-327-5522
Practice Address - Fax:520-327-5525
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ115981041C0700X
MA10295831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ83512Medicare ID - Type Unspecified