Provider Demographics
NPI:1891005161
Name:PICCOLA, TRISTA D (PHD, LISW-S)
Entity Type:Individual
Prefix:MS
First Name:TRISTA
Middle Name:D
Last Name:PICCOLA
Suffix:
Gender:F
Credentials:PHD, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26777 LORAIN ROAD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070
Mailing Address - Country:US
Mailing Address - Phone:440-716-2222
Mailing Address - Fax:440-716-1954
Practice Address - Street 1:26777 LORAIN ROAD
Practice Address - Street 2:SUITE 308
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-716-2222
Practice Address - Fax:440-716-1954
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.07001051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical