Provider Demographics
NPI:1174683148
Name:PICCIOLA, ANITA (LCSW)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:PICCIOLA
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:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-1254
Mailing Address - Country:US
Mailing Address - Phone:337-234-5656
Mailing Address - Fax:
Practice Address - Street 1:5 SECURITY BLVD
Practice Address - Street 2:STE F
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2777
Practice Address - Country:US
Practice Address - Phone:985-868-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X337Medicare ID - Type Unspecified