Provider Demographics
NPI:1841432408
Name:PICULELL, ROBERT HOWARD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HOWARD
Last Name:PICULELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9544
Mailing Address - Country:US
Mailing Address - Phone:518-869-0938
Mailing Address - Fax:
Practice Address - Street 1:544 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9544
Practice Address - Country:US
Practice Address - Phone:518-869-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 030472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker