Provider Demographics
NPI:1417263484
Name:PIAZZA, JANNETTE
Entity Type:Individual
Prefix:
First Name:JANNETTE
Middle Name:
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARRETERA 14 BO. MACHUELOS
Mailing Address - Street 2:CENTRO MEDICO DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-840-6630
Mailing Address - Fax:787-844-4130
Practice Address - Street 1:CARR.14 BO. MACHUELOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-123-4567
Practice Address - Fax:787-123-4567
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAC115620940101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)