Provider Demographics
NPI:1477956597
Name:PICARIELLO, ROBERT JAMES (MS, LMFT, CADC II)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:PICARIELLO
Suffix:
Gender:M
Credentials:MS, LMFT, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 NW KEARNEY ST
Mailing Address - Street 2:#205
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1400
Mailing Address - Country:US
Mailing Address - Phone:971-238-7777
Mailing Address - Fax:
Practice Address - Street 1:1962 NW KEARNEY ST
Practice Address - Street 2:#205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1400
Practice Address - Country:US
Practice Address - Phone:971-238-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12R-01101YA0400X
ORT0569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)