Provider Demographics
NPI:1750466512
Name:PIAZZA, CATHLEEN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:C
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1898
Mailing Address - Country:US
Mailing Address - Phone:402-559-8943
Mailing Address - Fax:
Practice Address - Street 1:888 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1898
Practice Address - Country:US
Practice Address - Phone:402-559-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE634103TB0200X
NJ35SI00626500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025287200Medicaid