Provider Demographics
NPI:1619187804
Name:PIASECKI, JAMES JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:PIASECKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2017
Mailing Address - Country:US
Mailing Address - Phone:610-964-8165
Mailing Address - Fax:215-951-0313
Practice Address - Street 1:4700 WISSAHICKON AVE
Practice Address - Street 2:SUITE 126
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4248
Practice Address - Country:US
Practice Address - Phone:215-951-0300
Practice Address - Fax:215-951-0313
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006020L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical