Provider Demographics
NPI:1487368205
Name:PICCIRILLO, ANDREA (LASAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PICCIRILLO
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 E CACTUS RD APT 244
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7750
Mailing Address - Country:US
Mailing Address - Phone:480-369-3339
Mailing Address - Fax:
Practice Address - Street 1:3140 N ARIZONA AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7166
Practice Address - Country:US
Practice Address - Phone:480-369-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15360101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ15360OtherLASAC