Provider Demographics
NPI:1689165730
Name:PICCIOTTA, ELIZABETH PERLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PERLA
Last Name:PICCIOTTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:JANE
Other - Last Name:PERLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10300 SAINT ALBANS DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2240
Mailing Address - Country:US
Mailing Address - Phone:615-496-7046
Mailing Address - Fax:
Practice Address - Street 1:5602 SHIELDS DR STE A
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3571
Practice Address - Country:US
Practice Address - Phone:615-455-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist