Provider Demographics
NPI:1114510484
Name:PIETRZYCKI, SHANAE LOVE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANAE
Middle Name:LOVE
Last Name:PIETRZYCKI
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 1:311 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4423
Mailing Address - Country:US
Mailing Address - Phone:520-610-1547
Mailing Address - Fax:
Practice Address - Street 1:311 VISTA DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4423
Practice Address - Country:US
Practice Address - Phone:520-610-1547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical