Provider Demographics
NPI:1821494543
Name:PICCIUTO, LEE (LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:LEE
Middle Name:
Last Name:PICCIUTO
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SEVEN FARMS DR
Mailing Address - Street 2:SUITE C-311
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8001
Mailing Address - Country:US
Mailing Address - Phone:843-637-9671
Mailing Address - Fax:
Practice Address - Street 1:295 SEVEN FARMS DR
Practice Address - Street 2:SUITE C-311
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8001
Practice Address - Country:US
Practice Address - Phone:843-637-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical