Provider Demographics
NPI:1336983824
Name:PICCOLO, CARMEN RYMER (LCSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:RYMER
Last Name:PICCOLO
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 1:1452 TAHITIAN SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-5944
Mailing Address - Country:US
Mailing Address - Phone:352-346-2306
Mailing Address - Fax:
Practice Address - Street 1:1452 TAHITIAN SUNRISE DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33565-5944
Practice Address - Country:US
Practice Address - Phone:352-346-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW226281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical