Provider Demographics
NPI:1942207410
Name:PICCIONE, PAUL M (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:PICCIONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CROSS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4119
Mailing Address - Country:US
Mailing Address - Phone:860-563-1480
Mailing Address - Fax:
Practice Address - Street 1:6 CROSS HILL RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4119
Practice Address - Country:US
Practice Address - Phone:860-563-1480
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1408103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical