Provider Demographics
NPI:1396825048
Name:PISONI, LOLETTE RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOLETTE
Middle Name:RAY
Last Name:PISONI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21000 N 75 AVE
Mailing Address - Street 2:BLDG 5
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6749
Mailing Address - Country:US
Mailing Address - Phone:623-362-3241
Mailing Address - Fax:440-756-2079
Practice Address - Street 1:21000 N 75 AVE
Practice Address - Street 2:BLDG 5
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-362-3241
Practice Address - Fax:440-756-2079
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPHD3171103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PHD3171Medicare ID - Type Unspecified
531784Medicare UPIN