Provider Demographics
NPI:1790019180
Name:PICCOLO, EUGENE R (MA)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:R
Last Name:PICCOLO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:PENNDEL
Mailing Address - State:PA
Mailing Address - Zip Code:19047-5707
Mailing Address - Country:US
Mailing Address - Phone:215-752-1541
Mailing Address - Fax:
Practice Address - Street 1:1517 DURHAM RD
Practice Address - Street 2:
Practice Address - City:PENNDEL
Practice Address - State:PA
Practice Address - Zip Code:19047-5707
Practice Address - Country:US
Practice Address - Phone:215-752-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health