Provider Demographics
NPI:1114167046
Name:PIASCIK, GARY (MFTI)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:PIASCIK
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:PIASCIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTI
Mailing Address - Street 1:PO BOX 79302
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0176
Mailing Address - Country:US
Mailing Address - Phone:951-768-2150
Mailing Address - Fax:
Practice Address - Street 1:6711 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1955
Practice Address - Country:US
Practice Address - Phone:951-352-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC60543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist