Provider Demographics
NPI:1477691590
Name:PICIUCCO, LUIGI (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUIGI
Middle Name:
Last Name:PICIUCCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 BUSINESS PARK DRIVE SUITE 207
Mailing Address - Street 2:
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:934-361-3984
Practice Address - Street 1:9700 BUSINESS PARK DRIVE SUITE 207
Practice Address - Street 2:
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:934-361-3984
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8312103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL83120OtherMEDICARE