Provider Demographics
NPI:1033276365
Name:PIASTUNOVICH, ARIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:
Last Name:PIASTUNOVICH
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 1:211 GOUGH ST 115
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6802
Mailing Address - Country:US
Mailing Address - Phone:415-335-0905
Mailing Address - Fax:
Practice Address - Street 1:211 GOUGH ST 115
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6802
Practice Address - Country:US
Practice Address - Phone:415-335-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW197661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP11865Medicare UPIN