Provider Demographics
NPI:1972482800
Name:PICCOLO, SETH SR (LCDP)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:
Last Name:PICCOLO
Suffix:SR
Gender:M
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 BOWLING LN
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02808-1100
Mailing Address - Country:US
Mailing Address - Phone:401-208-7413
Mailing Address - Fax:
Practice Address - Street 1:4705 OLD POST RD UNIT B
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-1842
Practice Address - Country:US
Practice Address - Phone:401-364-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP01060101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)