Provider Demographics
NPI:1467023325
Name:PICCIUTO, ELISE RACHEL
Entity Type:Individual
Prefix:MISS
First Name:ELISE
Middle Name:RACHEL
Last Name:PICCIUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 STANDISH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2633
Mailing Address - Country:US
Mailing Address - Phone:203-812-0838
Mailing Address - Fax:
Practice Address - Street 1:103 STANDISH AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2633
Practice Address - Country:US
Practice Address - Phone:203-812-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6899235Z00000X
CT18.006661-TEMP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist