Provider Demographics
NPI:1316156409
Name:PICARIELLO, ROBERT P (LMT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:PICARIELLO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13475 SW 9TH ST
Mailing Address - Street 2:APT A212
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1887
Mailing Address - Country:US
Mailing Address - Phone:954-447-8509
Mailing Address - Fax:
Practice Address - Street 1:13475 SW 9TH ST
Practice Address - Street 2:APT A212
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1887
Practice Address - Country:US
Practice Address - Phone:954-447-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 37665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist