Provider Demographics
NPI:1942498282
Name:PICKETT, PAUL FERGUSON (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FERGUSON
Last Name:PICKETT
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1643
Mailing Address - Country:US
Mailing Address - Phone:315-701-5850
Mailing Address - Fax:315-701-5850
Practice Address - Street 1:528 OAK ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1643
Practice Address - Country:US
Practice Address - Phone:315-701-5850
Practice Address - Fax:315-701-5850
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000258-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health