Provider Demographics
NPI:1679018329
Name:DIANE PISZKER
Entity Type:Organization
Organization Name:DIANE PISZKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PISZKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-C, SSW
Authorized Official - Phone:313-418-2285
Mailing Address - Street 1:1800 GRINDLEY PARK ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2553
Mailing Address - Country:US
Mailing Address - Phone:313-418-2285
Mailing Address - Fax:
Practice Address - Street 1:23854 WALLOON WAY
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-8307
Practice Address - Country:US
Practice Address - Phone:313-418-2285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010859661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty