Provider Demographics
NPI:1699385559
Name:PIANELLI, KRISTIN MARIE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:PIANELLI
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 1:975 AMETHYST DR SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-5872
Mailing Address - Country:US
Mailing Address - Phone:772-559-0801
Mailing Address - Fax:
Practice Address - Street 1:5080 TOPAZ LN SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-5863
Practice Address - Country:US
Practice Address - Phone:772-569-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB600065106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL802432Medicaid