Provider Demographics
NPI:1255353140
Name:PICO, DEANNA HALE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:HALE
Last Name:PICO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2651
Mailing Address - Country:US
Mailing Address - Phone:203-757-2833
Mailing Address - Fax:203-753-7618
Practice Address - Street 1:934 CHASE PKWY
Practice Address - Street 2:LOWR LEVEL
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2916
Practice Address - Country:US
Practice Address - Phone:203-815-5733
Practice Address - Fax:203-753-7618
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0046421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT511750OtherVALUE OPTIONS
CTP2943998OtherOXFORD HEALTH PLANS
CT004239986Medicaid
CT140004642CT01OtherANTHEM BC/BS
TX7675564OtherAETNA
CT300121OtherMANAGED HEALTH NETWORK