Provider Demographics
NPI:1932132834
Name:PICCOLO, ROBERT (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:PICCOLO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-0331
Mailing Address - Country:US
Mailing Address - Phone:406-202-0036
Mailing Address - Fax:
Practice Address - Street 1:555 FULLER AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3302
Practice Address - Country:US
Practice Address - Phone:406-202-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0501033Medicare ID - Type Unspecified