Provider Demographics
NPI:1902391774
Name:ELIZABETH PICCOLO NP IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:ELIZABETH PICCOLO NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PICCOLO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:845-639-0000
Mailing Address - Street 1:151 S MAIN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3544
Mailing Address - Country:US
Mailing Address - Phone:845-639-0000
Mailing Address - Fax:845-499-2537
Practice Address - Street 1:151 S MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3544
Practice Address - Country:US
Practice Address - Phone:845-639-0000
Practice Address - Fax:845-499-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401153363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty