Provider Demographics
NPI:1669442125
Name:PICERNO, MATTHEW RICHARD (PHD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RICHARD
Last Name:PICERNO
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 1:95121 VILLAGGIO DEGLI ULIVI
Mailing Address - Street 2:
Mailing Address - City:SIGONELLA
Mailing Address - State:CATANIA
Mailing Address - Zip Code:95121
Mailing Address - Country:IT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95121 VILLAGGIO DEGLI ULIVI
Practice Address - Street 2:
Practice Address - City:SIGONELLA
Practice Address - State:CATANIA
Practice Address - Zip Code:95121
Practice Address - Country:IT
Practice Address - Phone:314-624-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical