Provider Demographics
NPI:1003106360
Name:PIASECKA, JUSTYNA (MD)
Entity Type:Individual
Prefix:
First Name:JUSTYNA
Middle Name:
Last Name:PIASECKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUSTYNA
Other - Middle Name:PIASECKA
Other - Last Name:BERNABE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1011 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5061
Mailing Address - Country:US
Mailing Address - Phone:401-432-1000
Mailing Address - Fax:401-432-1000
Practice Address - Street 1:1011 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-5061
Practice Address - Country:US
Practice Address - Phone:401-432-1000
Practice Address - Fax:401-432-1000
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD158642084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry