Provider Demographics
NPI:1689153314
Name:PIETRUSZKA, MARIA (LP-MHC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PIETRUSZKA
Suffix:
Gender:F
Credentials:LP-MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ONDERDONK AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1506
Mailing Address - Country:US
Mailing Address - Phone:646-270-9475
Mailing Address - Fax:
Practice Address - Street 1:405 ONDERDONK AVE APT 2L
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1506
Practice Address - Country:US
Practice Address - Phone:646-270-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP05355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health