Provider Demographics
NPI:1689783433
Name:PIATANESI, THERESA ISLA (CDPT)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:ISLA
Last Name:PIATANESI
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0160
Mailing Address - Country:US
Mailing Address - Phone:360-682-4004
Mailing Address - Fax:360-678-3636
Practice Address - Street 1:105 NW 1ST ST.
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-0160
Practice Address - Country:US
Practice Address - Phone:360-682-4004
Practice Address - Fax:360-678-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00053356101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00053356Medicare UPINCDPT