Provider Demographics
NPI:1194703504
Name:PISANO, RICHARD LOUIS (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:PISANO
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 1:745 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2316
Mailing Address - Country:US
Mailing Address - Phone:508-771-3130
Mailing Address - Fax:508-771-3144
Practice Address - Street 1:745 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2316
Practice Address - Country:US
Practice Address - Phone:508-771-3130
Practice Address - Fax:508-771-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1832OtherSTATE ID
MA16412Medicare UPIN
MAW02008Medicare UPIN
MA010687Medicare UPIN
MA1832OtherSTATE ID
MA43785Medicare UPIN